ORAL ANSWERS TO QUESTIONS

HOME DEPARTMENT

The Secretary of State was asked—

Excessive Drinking

Andrew Stunell: What resources her Department is making available at a local level to help tackle the harmful effects on communities of excessive drinking.

Theresa May: The Government are providing direct support to 20 areas in England and Wales, including Greater Manchester, to tackle the harmful effects of excessive drinking, particularly alcohol-fuelled crime and disorder. We have also overhauled the Licensing Act 2003, giving local areas the tools and powers they need to deal with problem premises, and to secure a financial contribution towards policing the night-time economy.

Andrew Stunell: I thank the Home Secretary for that answer, and particularly for the work that will be done in Greater Manchester. May I draw her attention to the plea of the director of public health for Stockport, who is concerned that the action of the alcohol industry is, to some extent, holding licensing authorities to ransom? Will she include that in her consideration of this important matter?

Theresa May: My right hon. Friend makes an important point, and we want to ensure that licensing authorities can use the tools and powers that the Government have given them. We gave them those tools and powers for a very good reason and because of our concern on two counts relating to alcohol abuse and the problems that arise from it—the cost to the police and society generally of crime and disorder related to alcohol, and also the health costs that arise.

Alex Cunningham: A report by The Lancet estimated that there were more than 200,000 alcohol-related crimes in the north-east in just a year, and that a minimum unit price would save 860 lives a year and cut hospital admissions by 30,000. Is it time that the Secretary of State totally disregarded the drinks industry lobby and introduced a minimum unit price to help make people healthier and safer at home?

Theresa May: We are going to introduce a ban on the sale of alcohol below the cost of duty plus VAT. That was a coalition agreement commitment, which will be introduced this April. We are also working with the industry and challenging it to ensure that it raises its game in dealing with problems related to excessive binge drinking and alcohol use, and we will watch what happens. Obviously Scotland is moving on the minimum unit price. There are legal issues and it will be interesting to see what evidence arises from that.

Kelvin Hopkins: Following the question from my hon. Friend the Member for Stockton North (Alex Cunningham), some of us believe that the primary problem with alcohol is a health problem rather than one of disorder and crime. Is the Home Secretary working closely with the Department of Health to ensure that we deal with alcohol seriously?

Theresa May: Yes, I assure the hon. Gentleman that we work closely with the Department of Health on this issue. Although the Home Office leads on alcohol strategy, the strategy work is done by both the Home Office and the Department of Health.

Immigration

Laurence Robertson: What steps she is taking to bring about a reduction in gross and net immigration to the UK.

Theresa May: Since 2010 we have reformed all routes to the UK, tightening areas where abuse was rife. In particular, around 700 colleges can no longer bring students into the UK, but at the same time, sponsored visa applications for university students increased by 7% in the past year. In the areas where we can exert control, our reforms are working and have cut non-EU migration to its lowest level since 1998.

Laurence Robertson: I thank the Home Secretary for that answer. Most statistics are quoted as net migration figures, although most people are concerned about the number of people coming to this country. Is it important to assess gross immigration figures when talking about these issues?

Theresa May: Obviously it is important to consider all migration figures, and uncontrolled gross immigration does put pressure on our public services and infrastructure. As the immigration Minister pointed out, the people who suffer most from the impact of uncontrolled immigration are those at the lower end of the income scale. Indeed, the hon. Member for Dagenham and Rainham (Jon Cruddas) said that the previous Labour Government used migration
	“to introduce a covert 21st-century incomes policy.”

Keith Vaz: Last Thursday the immigration Minister scolded the metropolitan elite, which included members of the Cabinet, for employing people who were born outside this country. Some 4.4 million people who were born outside this country are contributing to our economy, and what the immigration Minister said came dangerously to endorsing the discredited slogan of “British jobs for British workers.” When the Minister speaks in Harrow next Wednesday, will the Home Secretary ask him to return to his normal sensible demeanour, and let us have a constructive debate on immigration, rather than relying on stereotypes and clichés?

Theresa May: A constructive debate on immigration was exactly what my hon. Friend was contributing to, and I do not accept the right hon. Gentleman’s description of his speech. As I said in answer to the question from my hon. Friend the Member for Tewkesbury (Mr Robertson), the immigration Minister was pointing out that uncontrolled immigration has greatest impact on those at the lower end of the income scale. I would have thought that as a Labour Member of Parliament, the right hon. Gentleman should care about that.

John Baron: Given that freedom of movement within the EU is the elephant in the room of the immigration issue,
	what plans do the Government have to reform that part of the EU strategy? It might have been suitable for the founding fathers, but given that there are now 28 member states with disparate economic cycles, it is past its sell-by date. Otherwise, we should stop talking about targets.

Theresa May: My hon. Friend makes an important point about free movement. I have been party to discussions and have raised the issue, particularly on the question of the abuse of free movement, within the EU. Many other member states are concerned. We are taking action with them to cut out the problems of the abuse of free movement.
	My hon. Friend also mentioned the disparity of incomes among accession countries. My right hon. Friend the Prime Minister, in an article he wrote some weeks ago, suggested that a future approach might be not allowing full free movement rights until accession countries have reached a certain income level compared with the rest of the EU.

Angus MacNeil: When will we see an end to the persecution of Scottish fishing boats and their good foreign crews by the UK Border Agency? Boats from my constituency have been tied up and money is being lost because of the stupid obsession with immigrant numbers. The message should be that immigrants are good and we need them. Will the Home Secretary help Scottish fishing boats to work rather than cause them to waste their time and to be tied up?

Theresa May: My understanding is that there is a limit on the number of days that fishing boats can go out to fish, and that that is absolutely nothing to do with UK Visas and Immigration—if I might remind him, the UK Border Agency was abolished close to a year ago. I know that good work is being done—I saw this in Aberdeen recently—by UK Border Force, UK immigration enforcement, the National Crime Agency, Police Scotland and others to ensure that we get rid of the abuse that takes place in the fishing industry, particularly on issues such as trafficking.

Andrew Selous: May I encourage the Home Secretary’s review of free movement within Europe, which is incredibly important? We would all like to hear more from her on how we take it forward

Theresa May: I am grateful for my hon. Friend’s encouragement. As I have said, in the past nearly four years, I have seen growing concern on free movement among European Union member states. The UK has raised and pursued the matter. We are now working with other member states, particularly on the abuse of free movement, but we need to look ahead to future accession treaties, and the terms in which free movement is included in them.

David Hanson: The Prime Minister has said that the Government would get net migration down to the tens of thousands by 2015, “no ifs, no buts”, and yet this month, the figure has risen to more than 212,000. The question is simple. Will the Government meet their net migration target—yes or no?

Theresa May: We are continuing to deal with net migration. [Interruption.] I fully accept that the most recent figures, which show an increase in migration from the EU, have made the task more difficult, but it ill behoves Labour Members to talk in those terms when they had an immigration policy that meant there was uncontrolled immigration throughout their period in office.

Duncan Hames: A successful Wiltshire businesswoman who has created jobs for dozens of local people and paid her fair share of taxes faces her family being wrenched apart on account of her mother being denied leave to remain. How can we ensure that wealth creators—people who create jobs for our constituents —are not made to feel unwelcome here by changes to the family migration route?

Theresa May: I am sure that the hon. Gentleman will want to raise individual cases with my hon. Friend the Minister for Security and Immigration. In overall terms, we have changed all routes of entry into the United Kingdom, which has had an impact on non-EU migration, which is at its lowest since 1998. The hon. Gentleman talks about wealth creators, and it is important that we differentiate in the system. We are cutting out abuse and ensuring that the brightest and the best can come to the UK.

TPIMs

Cathy Jamieson: What additional funding she has made available to the security agencies to cover costs associated with the ending of TPIMs.

Gemma Doyle: What additional funding she has made available to the security agencies to cover costs associated with the ending of TPIMs.

James Brokenshire: Additional funding of tens of millions of pounds has been made available to the police and the Security Service each year for surveillance, technical capabilities and other measures to mitigate the overall risk as part of the TPIMs package. That has significantly enhanced the police and Security Service’s counter-terrorism capabilities.

Cathy Jamieson: Will additional funding continue to be made available to the police and the security services specifically to manage those suspects who otherwise would have been on TPIMs?

James Brokenshire: I am grateful to the hon. Lady, because her question allows me to confirm that there is no intention of reducing the additional funds that have been made available. We have also increased spending on the security and intelligence agencies, and protected counter-terrorism policing budgets to ensure that capabilities are maintained. That includes resources for surveillance and the management of TPIMs subjects.

Gemma Doyle: There are reports that around 400 Brits have travelled to Syria to fight in the terrible conflict there, and that around 250 of them have returned to the UK. There is therefore a pressing and urgent need to set
	out the measures which will be used to manage the threats that individuals may pose to the UK after TPIMs expire. Why is there a delay in providing the details of those measures?

James Brokenshire: There is no delay. The UK has some of the most robust and effective legislation in the world to deal with terrorist suspects and we will not hesitate to use every power at our disposal to protect the security of this country. The hon. Lady makes a fair point in relation to travel to Syria. We are very clear that people should not travel to Syria, and our counter-terrorism legislation is there to uphold the law. We are using the royal prerogative to remove passports from British nationals who it is believed wish to travel abroad to take part in activities such as terrorist training or other fighting.

Charlie Elphicke: Does the Minister agree that many of the problems we have with counter-terrorism and TPIMs would be made vastly easier if we had reform of European human rights so that we can ensure that the Supreme Court is supreme once again?

James Brokenshire: My hon. Friend has consistently made this point about human rights, and he is obviously well aware of a number of the measures that we have been looking at. Clearly, we have taken steps to ensure, for example, that we are better able to deport individuals and that our focus remains on deportation with assurance to ensure that those who would cause us harm and can be removed are removed from this country.

Robert Buckland: Does my hon. Friend agree that TPIMs are but a part of the array of powers available to the police and surveillance services to protect us from harm, and that they are far more able to withstand the sort of legal challenges that caused huge problems under the previous control order regime?

James Brokenshire: My hon. Friend makes an important point. What the Opposition do not say when they raise this issue is that control orders were struck down on a number of occasions for a range of reasons. I am clear that prosecution is always the best route to deal with terrorists, and we should recognise the success of our agencies in securing the conviction of 40 individuals for terrorism-related offences in the past year.

Female Genital Mutilation

Karl Turner: What steps she is taking to increase the number of people who are investigated and charged for carrying out female genital mutilation.

Theresa May: Government Ministers have signed a declaration which reaffirms our commitment to protecting current and future generations of girls from this abuse. We are working closely with the Director of Public Prosecutions to increase investigations for FGM and are considering suggestions for strengthening the criminal law. The Government are determined to do all we can to bring perpetrators to justice.

Karl Turner: I congratulate the Government on the work that they have done recently to deal with this shocking criminal offence, but will the Home Secretary commit to a national campaign to raise awareness of FGM and the fact that it is a serious criminal offence, similar to campaigns such as that on domestic violence?

Theresa May: The hon. Gentleman makes an important point in two ways for those who are potentially at risk of being victims of female genital mutilation. First, it is important that they understand their situation. Secondly, it is important that those who are aiming to undertake or arrange for others to undergo FGM know what the law is and where they stand in relation to it. The Government have indeed produced a campaign. We have launched a new communications campaign in relation to this issue. I also refer the hon. Gentleman to the “Statement opposing female genital mutilation”, which is a pocket-sized leaflet that sets out the law. About 41,000 statements have already been distributed across the UK in 11 languages.

Nicola Blackwood: FGM by its nature is a secretive crime, often perpetrated by close relatives of the victims, too many of whom are very young and too frightened to seek help. What is the Home Secretary doing to ensure that the police and the Crown Prosecution Service have the training and expertise necessary to take a proactive approach to identifying and protecting these very young victims, rather than simply hoping that they will come forward of their own volition?

Theresa May: My hon. Friend also makes important points about this issue. We are working with the victims that she mentions and, in particular, we are doing some work with the Director of Public Prosecutions. Everybody in the House is frustrated that there has not been a prosecution yet. We want to see prosecutions because that can make it clear to people what they are doing and what is at risk when they undertake this crime.

Andrew Gwynne: The Education Secretary has agreed to write to all schools in England about FGM, following intense pressure from this side of the House and the brave campaign by Fahma Mohamed. Given that, what further discussions has the Home Secretary had with her colleagues in government in order to ensure that health staff, social workers and those working for other Departments and agencies report to the police any instances of FGM they have identified?

Theresa May: Ensuring that incidents are reported is important, and on 6 February the Department of Health announced that for the first time ever, from April, all NHS acute hospitals must provide information on patients who have undergone female genital mutilation. That will provide key information about the incidence and prevalence of FGM and will support social services and the police in their work by ensuring that they can target those areas where it is taking place.

Greg Mulholland: The House is united in wanting to see people prosecuted for this appalling crime. Even more, we want to see it stamped out all together. What is being done to ensure that those
	young women who are threatened—and their family members—have a confidential way to report the possibility that it will happen to them?

Theresa May: We are taking a genuine cross-Government approach to the issue. It is being co-ordinated by the Minister for Crime Prevention, my hon. Friend the Member for Lewes (Norman Baker), but we are bringing in the Department for Education, the Department of Health and the Department for International Development, which is putting in significant funds to try to deal with the problem at source overseas, both in those communities where the culture is strong—feeding back into diaspora communities in the UK—and where there are individuals performing this act on young girls, to ensure that we can eradicate it.

Huw Irranca-Davies: One of the greatest challenges in tackling this issue—in terms of prosecutions and protecting the young women and, often, babies who are affected—is the level of awareness among social workers, police and other agencies. That challenge has been identified in Wales, and I suspect it is the same in England. What is the Home Secretary doing in Whitehall and on a cross-border basis with colleagues in Wales to ensure that we have a uniform approach to tackling the issue?

Theresa May: I am happy to say to the hon. Gentleman that on issues of this sort—and on the violence against women and girls agenda generally—we work with the Welsh Government and others. We are always willing to look at experience and practice, as well as at what others have found useful in dealing with this appalling crime.

James Clappison: May I warmly welcome the Government’s declaration on female genital mutilation? Does my right hon. Friend agree that political or cultural sensitivities should never get in the way of tackling what is an awful abuse and crime?

Theresa May: My hon. Friend is right. This is an appalling abuse of young girls and we should ensure that we deal with it as such. It is right that we should not allow cultural sensitivities or concerns to get in the way of dealing with what is, at root, a crime.

Bogus Students

Stephen McCabe: How many sponsor notifications of potentially bogus higher education students there have been since 2010; and how many have been actioned to date.

James Brokenshire: UK Visas and Immigration received 315,598 notifications between 2010 and 2013 from all Tier 4 sponsors, of which 299,586 were actioned in the same period. All notifications receive an initial consideration within 28 days of receipt.

Stephen McCabe: May I wish the Minister well in his new post? The issue of bogus students figured strongly in his recent Demos speech, even if it did not get quite the same prominence in the press. Of the backlog of 153,000 notifications that the chief inspector has identified,
	how many have now been attended to? When I next ask him this question, will that backlog figure have gone up or come down?

James Brokenshire: As I said, all notifications received from sponsors receive an initial consideration within 28 days of receipt. Notifications can be for a number of different reasons, whether that is failure to enrol or whether there is something serious that may mean students, or their dependents, have their leave curtailed. As the hon. Gentleman knows, I am looking closely at sponsorship and whether the thresholds for sponsors on the failure rates for students that they put forward, are appropriate. I assure him that I am looking very closely at this issue.

Julian Brazier: My hon. Friend will be aware that net movements of students are the largest non-EU contributor to net inflow. Will he look beyond bogus students and ask whether, at a time when we have very high levels of graduate unemployment, it is right that there is an automatic right to remain for someone who graduates here and gets a job?

James Brokenshire: Our focus is on attracting the brightest and the best. It is important to note that applications for visas from outside the EU to universities have gone up by 7%. My hon. Friend will know that requirements and rules are in place to restrict how students can stay on—university graduates can stay if they get a graduate job earning £20,300, and there are certain other requirements—but we keep them under review.

Extremism

Henry Smith: What steps she is taking to prevent extremism.

James Brokenshire: Under the Government’s Prevent strategy, which aims to stop people becoming involved in and supporting terrorism, we work closely with local authorities, the police, and other agencies to confront and disrupt extremism. The Prime Minister’s extremism taskforce has identified further practical steps to strengthen our response to all forms of extremism, and these are being taken forward.

Henry Smith: What increased steps are being taken to meet the security threat from British-born foreign fighters coming back from Syria? How can local communities in this country, where they identify radicalisation, be better supported?

James Brokenshire: I thank my hon. Friend. I know the particular focus he attaches to this issue in relation to his constituency. Syria is the number one destination for jihadists anywhere in the world. Our priority, through the Prevent strategy, is to dissuade people from travelling there. Messages are given at a local level, and I note that in my hon. Friend’s Crawley constituency there has been a community briefing event to discuss Syria-related issues and that faith leaders are taking an active role. I welcome that community action.

Barry Sheerman: Does the Minister agree that if we are to tackle extremism at the roots we must do something about our schools,
	which even now have been neglecting the whole citizenship agenda? Is he as disturbed as I am by certain spokespeople on the radio and television denigrating democracy as a form of government? Is it not at school that we should be extolling the virtues of living in a free and open democratic system?

James Brokenshire: I thoroughly endorse what the hon. Gentleman says. Many Members from across the House go to schools to underline key points on democracy and the values that define our country, and that work continues in our schools. The Department for Education is a key partner in the work of Prevent and in examining steps to be taken forward by the Prime Minister’s extremism taskforce.

Michael Fabricant: My hon. Friend will know that there are websites and social media that seek to radicalise young Muslims in our community. What steps is the Home Office taking to try to interfere with, or completely stop, those websites and social media?

James Brokenshire: My hon. Friend makes an important point on the impact of online radicalisation. The counter terrorism internet referral unit is removing more illegal terrorist content than ever before—since 2010, it has removed more than 26,000 pieces of illegal terrorist material online—but there is more work to do. We continue to work with the industry to ensure that, where we can prevent extremist material from getting into people’s homes, that is precisely what we will do.

Julian Huppert: Has the Minister seen the evidence which shows that counter-speech is one of the most effective ways of driving people away from information online? Will he put more effort into supporting it, so that we can divert people from extremism?

James Brokenshire: As the hon. Gentleman says, it is important to ensure that different perspectives and points of view are articulated online. I continue to have discussions with internet service companies about how we can best help them with the good work that many are doing in helping community organisations to provide that counter-narrative.

Rape

Madeleine Moon: What assessment she has made of the proportion of reported rapes which resulted in prosecution or conviction in the last two years.

Norman Baker: Rape is a devastating and under-reported crime. However, the coalition Government is committed to improving the response to rape at every point in the criminal justice system, which includes improving referrals from the police to the Crown Prosecution Service.

Madeleine Moon: Whatever the rate of civilian success in prosecuting and investigating rape, it is higher than that in the Ministry of Defence system. Will the Minister agree to work with the MOD to improve joint police investigation and service prosecution of rape in the military justice system?

Norman Baker: We are, of course, aware of one particular instance, of which the hon. Lady is doubtless also aware. I know that the Ministry of Defence has apologised to the family concerned for the failures that the coroner identified in that case. I shall be happy to work with my colleagues in the Ministry of Defence to ensure that all the help that we can give them is available.

James Gray: Successful prosecutions and help for victims have increased significantly in recent years. That is great, but does the Minister agree that rape is one of those crimes which are often not reported, particularly in certain communities in the United Kingdom, because of perceived shame or reticence? Could we not do more to encourage victims to discard that shame and be prepared to come forward and report the crime to the police?

Norman Baker: I entirely agree. It is important for victims to come forward and to have confidence in the police. Indeed, I believe that that is the trend we are now seeing. Although, according to the Crime Survey for England and Wales, there has been a decrease in the number of sexual assaults, there has been a significant increase in the number of rapes reported to the police. That suggests that more people are confident about coming forward, which I welcome.

Helen Jones: Will the Minister admit that, while on his watch the number of reported rapes is increasing, the number of files passed to the Crown Prosecution Service has fallen by a third, and in the Met the number of referrals is down by 43%? When will he accept responsibility for that, and admit that the Government’s decisions to remove suspected rapists from the DNA database and to cut the police force have let victims down and are allowing criminals to get away with it?

Norman Baker: I did expect a very authoritarian question from a Labour Member. I wonder what the Labour party’s supporters in Islington and Hampstead make of its approach to Home Office questions.
	The serious issue is that the CPS is currently involved in discussions with the police about rape referral levels in a number of forces. The Ministry of Justice and others are implementing the six-point plan to which the Attorney-General referred last year. The hon. Lady may also be aware that, along with the Minister for Policing, Criminal Justice and Victims, I have written to all chief constables and police and crime commissioners urging them to take rape even more seriously than they do already.

Police Funding

Jim Cunningham: What assessment she has made of the effect of reductions in funding to local authorities on police forces.

Damian Green: Funding for local authorities is a matter for the Secretary of State for Communities and Local Government. The Police Reform and Social Responsibility Act 2011 introduced two related, reciprocal duties for police and crime commissioners to co-operate with partners. PCCs are already working with local
	leaders to achieve effective outcomes for their areas, and we encourage them to continue to do so. In Hampshire. for example, fire and police authorities and the county council are joining up corporate services, and expect to save up to £4 million a year.

Jim Cunningham: Street wardens, neighbourhood wardens and police community support officers are key to neighbourhood policing, but huge cuts in local authority budgets are forcing councils such as Coventry city council, West Midlands county council and others throughout the country to cut their funding for what local communities want: wardens and PCSOs on their streets. Does the Home Secretary not recognise the damage being done to neighbourhood policing, and the increasing burden that she is placing on our police service?

Damian Green: I disagree with the premise of that question, and so do the hon. Gentleman’s constituents and others across the west midlands. Some 87% of the public say that they are satisfied with the West Midlands police—a greater percentage than in the country as a whole—and the west midlands has amongst the highest levels of victim satisfaction in the country. The reason for that is probably that the most recent statistics show that, in the year to September 2013, recorded crime in the west midlands was down 1%.

Priti Patel: Does the Minister agree that central to cutting crime is how we deploy our police forces? This is not about targets or bureaucracy; it is about ensuring that the police are deployed in the right way to focus on cutting neighbourhood crime.

Damian Green: My hon. Friend is right. Indeed, the inspectorate of constabulary has found that a higher proportion of police officers are visible on the front line, where people want to see them. That is why our streets are safer now than they have been for decades.

Jack Dromey: Police community support officers, local men and women on the beat, are much loved and much respected in communities throughout the country and the bedrock of neighbourhood policing. With councils now hit hard by the biggest cuts in local government history, 3,366 PCSOs have gone since the general election. Does the Minister recognise local communities’ mounting concern about the loss of their PCSOs? Will he join me in welcoming the commitment to put 500 PCSOs back on the beat, which is now being honoured by Labour Wales?

Damian Green: I agree with the hon. Gentleman to the extent that I absolutely value the work of PCSOs, but he is deluding himself if he thinks that the streets are becoming less safe and that neighbourhood policing is in retreat. Neighbourhood policing is at the heart of the policing model operated by this country’s forces. Over the past few years, they have collaborated better with local government and the NHS so that every pound they spend is more visible on the streets and is being shown in the consistent reduction in crime.

James Morris: The reality is that crime is falling. Does the Minister agree that it is precisely at a time of pressure on budgets
	that the police should look at innovative ways of working with local authorities, the voluntary sector and other partners to deliver services that keep people safe in their communities?

Damian Green: My hon. Friend is right. He represents part of the west midlands, as does the hon. Member for Coventry South (Mr Cunningham) who asked the original question. My hon. Friend will know that the police innovation fund had a successful bid from the west midlands. That will mean that a new public sector intelligence hub will be created, bringing together local councils, the NHS, other services and the police. That will enable them to share information in a way that will make them much more effective at fighting child sexual exploitation. It is that kind of work that reduces crime.

Immigration

Stephen Metcalfe: What comparative assessment she has made of trends in the levels of EU and non-EU migration; and if she will make a statement.

James Brokenshire: Our reforms have cut non-EU migration to its lowest level since 1998 and there are now 82,000 fewer non-EU nationals arriving annually than when this Government came to power. Net migration of EU nationals and their family members, who are not subject to formal immigration controls, has doubled over the last year. Across Government, we are working hard to address the factors that draw people to Britain for the wrong reasons.

Stephen Metcalfe: Does my hon. Friend agree with the comments of the German Chancellor, Angela Merkel, that freedom of movement should not mean freedom to claim and that the only way to tackle this is through the Prime Minister’s plan to reform the EU?

James Brokenshire: I agree with what my hon. Friend has said. Freedom of movement is not and cannot be a freedom to claim benefits. The Government have introduced a series of domestic measures to restrict access to benefits and we are committed to working with our partners to reform the rules on access to benefits, which were designed for a different era and are no longer fit for purpose.

Steve Reed: Does the Home Secretary agree with the Institute of Directors that the Immigration Minister’s first major speech in his new job was
	“feeble, pathetic and divisive and more about political positioning than what is good for the country”?
	Did she see it in advance?

James Brokenshire: I did not know that I had been promoted but I will obviously answer the hon. Gentleman’s question. There is nothing feeble and weak about an immigration policy that continues to attract the brightest and the best to this country while resolutely focusing on reducing net migration to sustainable levels. That is why our policies are having an effect, reducing net migration from outside the EU by 82,000. What was feeble was the last Government’s failures that let immigration get out
	of control. It is their mess that this Government continue to sort out and with our reforms cutting non-EU migration to their lowest levels since 1998, we are having an effect.

Indian Students (Scottish Universities)

John Robertson: What estimate she has made of the number of students from India who have received visas to undertake studies at universities in Scotland in the latest period for which figures are available.

James Brokenshire: We do not have figures for the numbers of visas issued to Indian nationals for study at Scottish universities, but the latest higher education statistics show that India remains within the top five most common non-EU nationalities at universities in Scotland. We have cut abuse of student visas, but continue to attract the brightest and best students from around the world.

John Robertson: The Higher Education Statistics Agency says that Indian student numbers on higher education courses are down by 25% since 2011 alone and in Scotland they are down by 32%. What does the Minister think is the reason for that and why is Scotland so much worse off than the rest of the UK?

James Brokenshire: We have seen falls in student numbers from India, but we have also seen that in the USA and Australia, so a similar picture has been seen. However, visa applications from sponsored UK universities increased by 7% in 2013 and he may want to look at the figures for sponsored visa applications relating to the university of Glasgow, which are up 24%; for Heriot-Watt university, which are up 13% and for the university of Strathclyde, which are up 16%. We continue to attract the brightest and best and that is what our policy is doing.

Andrew Bridgen: Will the Minister outline to the House how the highly trusted sponsor scheme will allow the assessment of the ability and intention of students to complete their courses in this country?

James Brokenshire: As my hon. Friend has highlighted, sponsors do have responsibilities, and I responded to a previous question on the notifications they provide in relation to their students. We do need to keep a clear focus on those responsibilities and it is my view that where the Home Office is receiving applications from those universities, the failure rate is high and that does need to be examined further.

Mr Speaker: Keeping our clear focus on Scotland, I call Mr Pete Wishart.

Pete Wishart: Of course the Minister knows the rises he pointed out in his answer to the hon. Member for Glasgow North West (John Robertson) are all down to the reciprocal arrangement with China. That figure is down 25% from Pakistan, and down 14% from Nigeria. This Government’s United Kingdom Independence party-based immigration policies are hurting our universities and our ability to
	attract students to Scotland. Why should our universities suffer because of the appalling race to the bottom between the Minister’s Government and UKIP?

James Brokenshire: It is important to welcome the fact that we have seen an increase from China of 6%. The figure is also up 3% from Malaysia and 15% from Hong Kong. That shows there is nothing intrinsic in our policies that is putting off high quality students. That is why we are focused on ensuring that we continue to attract the brightest and the best to the whole of the UK and Scotland, and there is nothing to suggest that our policies are having any negative impact on that.

BME Police Officers

Stella Creasy: What assessment she has made of the change in the number of black and minority ethnic police officers in England and Wales since 2010.

Damian Green: From March 2010 to March 2013 the proportion of black and minority ethnic officers has increased from 4.6% to 5%. While the police work force is more representative in terms of gender and ethnicity than it has ever been, there is still much more to be done by forces.

Stella Creasy: One in three of my constituents is from a black and minority ethnic background but that is true of only one in 10 of our police. Does the Minister recognise that in communities like mine in east London that can lead to an undermining of confidence that our police are drawing from the widest talent pool possible in serving our capital city? If he does agree that that is a problem, will he back our plans to fast-track action to do something about it?

Damian Green: I agree completely with the hon. Lady that this issue needs addressing. I am happy to tell the House that it is being addressed. The Metropolitan police plan to recruit 5,000 new constables between now and 2015, and their aim is that 40% of them should be from a minority background, to reflect the population of London as a whole. This indeed is a serious issue, which the Metropolitan police are addressing.

Immigration Bill (Red Tape)

Meg Hillier: What assessment she has made of the potential effect of the Immigration Bill on red tape for businesses.

Karen Bradley: The Government have published a number of impact assessments in relation to the provisions in the Immigration Bill, setting out the costs and benefits of the proposals. These include an assessment of the impacts on businesses.

Meg Hillier: I welcome the Minister to the Dispatch Box. It is good to see another woman on the Conservative Front Bench—one who is speaking this time.
	During the Immigration Bill Committee, the former Immigration Minister, the hon. Member for Forest of Dean (Mr Harper), promised that there would be a mechanism to enable constituents who were extending their leave to remain to have the right documents in order to prove that to landlords and others, as required under the Bill. Can the Minister give me any update on how long that will take to come into place? If not, perhaps she could write to me.

Karen Bradley: I thank the hon. Lady for her question. I know that she worked very hard on the Immigration Bill Committee. We will look carefully at what she said and respond shortly.

Christopher Pincher: I congratulate my hon. Friend on joining the Treasury Bench.

Michael Fabricant: Staffordshire for ever!

Christopher Pincher: Staffordshire for ever, indeed. The previous Labour Government were guilty of not imposing red tape on transition controls, which led to thousands of European migrants coming to this country. Does my hon. Friend agree with the former Home Secretary, the right hon. Member for Blackburn (Mr Straw), when he said that that was a spectacular mistake?

Karen Bradley: I thank my hon. Friend, a fellow Staffordshire MP, for his question. He is quite right. The Immigration Bill is a sensible measure that will help this country to protect against illegal immigration. It is a well-needed measure and something we should be bringing in sooner rather than later.

Antisocial Behaviour

Bridget Phillipson: What recent steps she has taken to reduce antisocial behaviour.

Norman Baker: We are introducing measures through the Anti-social Behaviour, Crime and Policing Bill that put victims at the heart of the response to tackling and reducing antisocial behaviour. Front-line professionals will have faster, more effective powers better to protect the public, and people will have a voice in how agencies tackle their problems through the community trigger and the community remedy.

Bridget Phillipson: I am grateful to the Minister for that answer, but he knows that antisocial behaviour remains a major concern. Constituents stress to me that agencies need to work together more quickly, and especially more effectively, to tackle it. What more can the Minister do to make that happen?

Norman Baker: I recognise that the hon. Lady thinks this is a problem in her constituency and has done some work on it. I acknowledge that. The measures we are taking through the new range of powers will not only give more flexibility to agencies. The community remedy will encourage agencies to work together, as I mentioned a moment ago, and the fact that perpetrators will have
	to take responsibility for their actions—dealing with them that way, through the new powers—will help to drive down antisocial behaviour.

Julian Sturdy: Will the Minister join me in welcoming proposals from students at York university to establish a Street Angels-style initiative? The aim is to combat antisocial behaviour and to prevent alcohol and drug-related tragedies for those who find themselves in particularly vulnerable situations.

Norman Baker: I very much welcome that sort of local initiative and I congratulate those involved in the York university activity. That is why we have done away with the old top-down approach and given the agencies the freedom and flexibility that they need to make a difference locally.

Topical Questions

Alec Shelbrooke: If she will make a statement on her departmental responsibilities.

Theresa May: Since my statement last Thursday, hon. Members will have had the opportunity to read for themselves Mark Ellison’s report into the investigation of the murder of Stephen Lawrence, as well as that of Operation Herne into allegations of misconduct by the special demonstration squad. Both reports’ findings are deeply shocking. They will have an impact for the police, particularly the Metropolitan police, for years to come.
	I have asked the chief inspector of constabulary to look at the anti-corruption capability of forces so that we can ensure that forces have all the capability that they need to pursue corruption. We must continue the programme of integrity and anti-corruption measures that I set out on Thursday.
	Our reforms are changing the culture of the police through direct entry, a new code of ethics, greater transparency and professionalisation, and reform of the Independent Police Complaints Commission. I am also, as I said on Thursday, tabling amendments to the Criminal Justice and Courts Bill to introduce a new offence of police corruption.
	From this autumn, the police will for the first time have the opportunity to bring in talented and experienced leaders from other walks of life to senior ranks, opening up policing culture. I believe that that is one of the most important reforms in shaping the police of the future.
	Finally, I am sure the whole House will want to join me in paying tribute to the family of Stephen Lawrence, who continue to live through experiences that the rest of us cannot imagine. They have done so with dignity and stoicism. They deserve truth and justice.

Alec Shelbrooke: I very much associate myself with my right hon. Friend’s comments. My constituents have raised with me the issue of scam sites dealing with passports and European health insurance cards, of which I, too, have been a victim. What pressure is she is bringing to bear on search engines to stop that shoddy ripping off of hard-working people?

Theresa May: My hon. Friend raises an important issue. The Government are already taking action to tackle rogue websites which masquerade as legitimate Government services, exaggerating the nature of the services they provide or deliberately underplaying the services that people can get for free or at a lower cost from official sources. The Government Digital Service is leading a cross-government exercise with organisations such as the Advertising Standards Authority, the National Trading Standards Board, Which? and search engines to raise awareness of the issue and ensure that enforcement action is taken, where appropriate. Ministerial colleagues have also met Google to discuss the enforcement of its policies for advertising on its search results pages. Google will continue to support us by removing misleading adverts and by closing the accounts of repeat offenders.

Yvette Cooper: I congratulate the hon. Member for Old Bexley and Sidcup (James Brokenshire) on his promotion and his ability to generate headlines in his new job, and welcome the hon. Member for Staffordshire Moorlands (Karen Bradley) to her post in the home affairs team.
	I join the Home Secretary in paying tribute to the Lawrence family, who have had to endure further betrayal with the information from the shocking Ellison review last week. Twenty-one years after the death of Stephen Lawrence, reforms are needed so that those failures do not continue to cast a long shadow over the vital and valiant work that so many police officers do each day and, in particular, so that we can build confidence among the black and ethnic minority communities. Does the Home Secretary therefore agree that the Independent Police Complaints Commission should now be replaced with a new, stronger police watchdog? Will she tell me whether she agrees with the four proposals I made in my letter to her on reforming stop and search—on section 60 of the Criminal Justice and Public Order Act 1994; on section 1 of the Police and Criminal Evidence Act 1984; on race discrimination; and on banning targets?

Theresa May: Of course it is important that we ensure that the IPCC is able to deal with the cases of complaints against police officers. I have been concerned for some time about the fact that the police have, in effect, been investigating serious and sensitive complaints against police officers themselves. That is why I am changing the arrangements for the IPCC, increasing its resources and ensuring that in future it will be taking on the serious and sensitive cases. It is also why we have provided a number of other new powers to the IPCC to ensure that it has the capability it needs. However, as I said on Thursday, I am of course continuing to look at this issue.
	I assure the right hon. Lady that we do need to look at stop and search. I have consulted on it and the Government are now finalising the package we wish to put in place in response to that consultation.

Yvette Cooper: I thank the Home Secretary for her answer, but given the seriousness of this, I urge her to go further and faster, both on the IPCC, which is simply not strong enough, and on stop and search. She and I agree that its targeted use is really important, but too many searches are simply not targeted at all. We have not heard anything from her since her statement in July;
	the critical Equality and Human Rights Commission was four years ago; and we are told now that reform is being blocked by regressive attitudes in No. 10. It turns out that the Prime Minister said before the election that he wanted to
	“free the police to do far more stopping and far more searching.”
	Does the Home Secretary agree with the Prime Minister or is she losing the argument within the Government?

Theresa May: What we all want is to ensure that stop and search, a particularly valuable tool for the police, is properly used by the police. The recent report by Her Majesty’s inspectorate of constabulary, which I requested, found that the stop and search powers were not being used properly in far too high a percentage of cases—about a quarter of the cases it looked into. Stop and search is important and a very valuable tool; when it is used properly and well targeted, it has the right impact. I am pleased to say that the Metropolitan police have already started to make some changes in their operation of stop and search, which is having some impact.

Jesse Norman: Trading standards officers and local police have seized more than 189,000 illegal cigarettes and more than 16 kg of illicit tobacco from shops in my constituency in the past 12 months. All of that is untaxed and much of it is counterfeit, but the existing penalties do little to stem the flow of this harmful trade. Does the Home Secretary share my view that trading standards officers should be given the power to shut down these shops where all other enforcement methods have failed?

Norman Baker: I agree that Trading Standards needs to take that issue seriously, as I believe it does. Of course, Her Majesty’s Revenue and Customs, which is responsible for criminal investigation of fiscal offences, is well aware of the loss of money to the Treasury as a consequence of that activity. The good news is that the UK Border Force is successfully active on this front. The Crown Prosecution Service will decide whether to charge and prosecute in particular cases.

Debbie Abrahams: Two women a week die at the hands of their partners or former partners. In Oldham, between October 2012 and September 2013, more than 5,300 women were subject to abuse, a third of whom were abused in front of children. With 13% fewer domestic violence cases being prosecuted, what are the implications for justice for these women?

Theresa May: The hon. Lady raises an important point. Last year, the figures showed that 76 women lost their lives at the hands of a partner, ex-partner or lover. That is lower than in previous years, but even one such case is one too many, and we are all agreed on that across the House. My hon. Friend the Minister for Crime Prevention is doing work on such issues, looking at prosecutions and at ensuring that the right response is available so that women can indeed see justice when they have suffered at the hands of a partner or ex-partner.

James Morris: The all-party parliamentary group on mental health, which I chair, recently launched an inquiry
	into crisis care. Will the Home Secretary outline what the Government are doing to ensure that when vulnerable people with mental health problems come into contact with the police, they get an appropriate level of care?

Damian Green: I congratulate my hon. Friend on his work on the all-party group, to which I gave evidence last week. On vulnerable people, my right hon. Friend the Home Secretary has commissioned Her Majesty’s inspectorate of constabulary to undertake a specific inspection of the treatment of all vulnerable people in custody, because that is an extremely important area, which requires improvement in the performance of the health service and the police and across the criminal justice system, which we are determined to make happen.

Nick Smith: When a retired police officer says that senior officers briefed him to report a fight involving alcohol as just drunk and disorderly rather than as a public order offence, I am concerned. What steps is the Home Secretary taking to ensure that targets do not lead to the massaging of crime figures?

Norman Baker: I assure the hon. Gentleman that we take alcohol issues very seriously indeed, including the way in which they are recorded by the police. There is a great deal of alcohol harm in this country: £21 billion is the cost to the public purse from antisocial behaviour, damage to the health service and lost productivity. As Ministers, we all expect the police to record crime accurately.

Stewart Jackson: One consequence of an unfettered free movement directive is that illegal gangmasters from the European Union operating in the fens are linked to antisocial behaviour and human trafficking. What action is the Minister taking to end that phenomenon?

Karen Bradley: I thank my hon. Friend for his question and I know how hard he works locally on that issue. The Government are taking firm action to combat illegal gangmasters in his constituency and elsewhere. We have set up a cross-Government multi-agency taskforce to apply the full range of enforcement powers. We are doubling the penalties on employers for breaching the national minimum wage and for employing illegal migrant workers, and we will bring forward a modern slavery Bill next Session to deal with that heinous crime.

Graham Jones: Is the Home Secretary aware of the numbers of UK nationals who are subject to an overseas arrest warrant for serious offences such as murder and child sex crimes?

Theresa May: Of course I am aware that a number of UK nationals are subject to such warrants. Indeed I applaud the work that is done by the National Crime Agency, particularly in some of the areas that the hon. Gentleman has identified, in relation to working with other police forces across the world to ensure that whoever and wherever the perpetrators are, they are brought to justice.

Priti Patel: Does the Secretary of State agree that alongside the police, the public and social services have a vital role to play in helping to identify the victims of domestic abuse and, importantly, ensuring that they are signposted to the right services that will help them?

Norman Baker: Yes, I wholly agree. If we are to end violence against women and girls, all front-line services have to play a crucial role. A multi-agency approach is vital, as indeed is a cross-departmental approach, and that is reflected in the updated action plan that we published at the weekend.

Diane Abbott: Ministers will be aware of how upset and repelled the community is that the self-same police force that was supposed to be finding Doreen and Neville’s son’s killers was actually engaged in spying on them to undermine their campaign. Inquiries are all very well, and reforms are all very well, but can we be given an assurance that we will know who authorised the spying on Doreen and Neville Lawrence?

Theresa May: The hon. Lady raises a very important point. I think that everybody in this House and across the country was shocked at the findings of the Ellison review, particularly at somebody from the special demonstration squad effectively being, in the terms that Mark Ellison put it, a spy in the camp around the Lawrence family. Every effort will be made to ensure that the truth comes out about that. If the hon. Lady has read the Ellison report, she will know that the record-keeping of the special demonstration squad was, to put it mildly, sadly lacking. However, every effort will be made. The Metropolitan Police Commissioner has made it clear that they will want to ensure that they are providing every piece of evidence possible to the inquiries that are taking place.

Simon Burns: Does the Home Secretary accept that, with regard to the despicable crime of FGM, her announcement earlier about the involvement of hospitals in helping to bring people to justice will be widely welcomed? Does she also accept that, if it is not already being done, there is also surely a role for GPs in being able to report where they come across instances of this terrible crime?

Norman Baker: I entirely agree that it is very important that the NHS plays a particularly good role. The public health Minister, the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), has been very active on this front and has made great steps forward. She is looking at how the whole NHS can help the cross-departmental effort to tackle this appalling crime.

Sheila Gilmore: In my constituency, many fairly young couples are struggling with the new rules on being able to marry someone from outside this country. They feel that they are being made to pay the price of the Government’s failure to keep to its migration targets. Has the Home Secretary now decided how to respond to the various reports on this or on whether any changes are going to be made?

James Brokenshire: We welcome those who wish to make a life in the UK with their family, work hard and make a contribution, but family life must not be established here at the taxpayer’s expense, and family migrants must be able to integrate. That is precisely what our rules are about. We believe that this is fair to applicants and to the public. The hon. Lady may know that there is an ongoing court case. Therefore, while we absolutely maintain our position on this, applications are currently being put on hold pending the outcome of that case.

Several hon. Members: rose—

Mr Speaker: I want to hear a couple more of my colleagues, but extreme brevity is now required.

Margot James: The Facewatch online crime reporting system makes it much quicker for businesses to report crime. Will my hon. Friend encourage more businesses and local authorities to follow the lead taken by the west midlands crime reduction team and introduce Facewatch elsewhere to reduce crime further?

Karen Bradley: I thank my hon. Friend, who is a doughty champion for businesses both large and small in her constituency. I am very interested by the Facewatch business, and I look forward to seeing it tomorrow in Farnborough at the security and policing exhibition, where I shall promote it and other UK businesses in selling these great services globally.

Huw Irranca-Davies: The Welsh Government have put their money where their mouth is and are funding 500 additional police community support officers. Will the Minister for Crime Prevention, the hon. Member for Lewes (Norman Baker), explain why his colleagues up and down the country are openly accusing Conservative councils of being hypocritical for not putting their money where their mouth is and supporting PCSOs?

Damian Green: I—[Interruption.] I am terribly sorry to disappoint the hon. Gentleman and Opposition Front Benchers by answering a question about policing, since I am the Policing Minister. He will know that across the country crime is coming down and a higher proportion of police officers are on the front line. The streets of Britain are safer today in England and in Wales than they ever have been since we started recording crime statistics.

Mr Speaker: Last but not least, I call Sir James Paice.

James Paice: Following the question asked by my hon. Friend the Member for Peterborough (Mr Jackson), does my right hon. Friend the Home Secretary accept that there are countless employers in the food and farming sector who do not use illegal gangmasters and who instead pay good pay and provide good accommodation for their workers, and that where there is job displacement it is because British workers are not prepared to do that work, rather than because employers are somehow taking on illegal migrants on the cheap?

Theresa May: My right hon. Friend will be aware of the seasonal agricultural workers scheme, which was a very particular scheme that ensured that people were brought across to do work in the agricultural sector. However, as my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs made clear in his
	speech to the Oxford Farming Conference recently, we need to look at ensuring that people here in the United Kingdom are able to take on the jobs that are available to them, and at the moment we have no intention of reintroducing the seasonal agricultural workers scheme.

European Council

David Cameron: With permission, Mr Speaker, I would like to make a statement on last week’s emergency European Council.
	What has happened to Ukraine is completely indefensible. Its territorial integrity has been violated and the aspirations of its people to chart their own future are being frustrated.
	This European Council sent a clear and united message to Russia that its actions are in flagrant breach of international law and will incur consequences. We agreed on a three-phase approach to stand up to this aggression and uphold international law: first, some immediate steps to respond to what Russia has done; secondly, urgent work on a set of measures that will follow if Russia refuses to enter dialogue with the Ukrainian Government; and thirdly, a set of further, far-reaching consequences should Russia take further steps to destabilise the situation in Ukraine.
	Let me say a word on each of those steps. First, as a response to what Russia has already done, we agreed on some immediate steps. We have suspended preparations for the G8 in Sochi indefinitely. As I told the House last week, my view is that it would be completely wrong for a G8 summit to go ahead at all under current circumstances. We decided to stop work on a comprehensive new agreement on relations between Russia and the European Union, and we immediately suspended the talks that were under way on a more liberal visa regime in the Schengen area—the thing that Russian Ministers and business delegations have pushed for more than anything else.
	Here in Britain, I have ordered an urgent review of all Government business with Russia. We have already announced that no Ministers or members of the royal family will visit the Sochi Paralympics. Many other planned ministerial-level contacts will be cancelled in current circumstances. All bilateral military co-operation is under review, with the presumption that we will suspend it, except for work carried out to fulfil international treaty obligations, such as European arms control inspections. I have ordered a review of licences for arms exports to Russia. It is hard to see how anything that could be used in Ukraine could be justified. As with other measures, it is best if possible to take these decisions in concert with our European allies.
	There has been intense work to persuade Russia to come to the negotiating table with the Government of Ukraine and to discuss its stated concerns face to face. The idea of such a contact group, including other countries and organisations, was one I first proposed to the Polish Prime Minister back in January. The European Council agreed it was essential for such talks to start within the next few days and for them to deliver progress quickly. We also agreed that if Russia did not co-operate there would need to be further measures—the so-called second phase—which would need to start rapidly.
	Therefore, at my instigation, the Council tasked the European Commission to begin work on additional measures which could be taken against Russia if these talks do not get going or do not start producing results. These will include asset freezes and travel bans. We are working closely with our American, European and other international partners to prepare a list of names, and
	these sanctions, plus the measures already agreed against Yanukovych and his circle, will be the focus of a meeting here in London tomorrow with key international partners.
	There is an urgent need to de-escalate tension in Crimea. We are all clear that any referendum vote in Crimea this week will be illegal, illegitimate and will not be recognised by the international community. In addition, I have to say that any campaign would be completely impractical as well as illegal. There is no proper register or proper campaign, and the territory is covered with troops. It is completely impossible for a proper referendum campaign to be carried out. As I discussed with Chancellor Merkel last night in Hanover, Russia can choose the path of de-escalation by signalling it understands that the outcome cannot be acted on as legitimate. Chancellor Merkel and I were clear that any attempt by Russia to legitimise an illegal referendum would require us to respond by ratcheting up the pressure further.
	Thirdly, and most significantly, we agreed that it was essential to stop Russia taking further unacceptable steps in Ukraine. The Council agreed that if further steps are taken by Russia to destabilise Ukraine, there will be additional and far-reaching consequences for the relationship between the Russian Federation on the one hand and the European Union and its member states on the other. The Council conclusions state that these consequences would
	“include a broad range of economic areas.”
	Britain played a leading role in helping to reach this agreement, including through a meeting I convened with fellow leaders from France, Germany, Italy and Poland on the morning of the Council. Such sanctions would have consequences for many EU member states, including Britain, but as I argued at the meeting, the costs of not standing up to aggression are far greater. Britain’s own security and prosperity would be at risk if we allow a situation where countries can just flout international rules without incurring consequences.
	Finally, we decided to send a political message of support to the Ukrainian Government and people. The interim Ukrainian President spoke at the European Council with great power and force. The Ukrainian people want the freedom to be able to choose their own future and strengthen their ties with Europe, and they want a future free from the awful corruption that they have endured for far too long.
	At the request of the Ukrainian Prime Minister, we therefore agreed to bring forward the signing of the political part of the EU’s association agreement with Ukraine, and we agreed to help Ukraine tackle corruption. The EU has now frozen the assets of 18 people linked to the former regime, and Britain has deployed a team to Kiev from our National Crime Agency to help the new Ukrainian Government go after ill-gotten funds and return them to the Ukrainian people.
	It is now vital that Ukraine proceeds towards free and fair elections that enable all Ukrainians, including Russian speakers and minorities, to choose their leaders freely, so Britain is now providing substantial and immediate technical assistance to Ukraine to support elections and assist with reforms on public finance management, debt management and energy pricing. Ukraine also needs support to stabilise and repair its economy. The EU agreed unilaterally to lower trade tariffs, and to work with the International Monetary Fund on a package of financial assistance to the Ukrainian Government.
	As I agreed with President Obama during our call this weekend, there is still an opportunity for Russia to resolve this situation diplomatically. It should engage in direct talks with the Ukrainians, return Russian troops to their bases in Crimea, withdraw its support for this illegal and unconstitutional referendum in Crimea, and work with the rest of the international community to support free and fair elections in Ukraine in May. No one should be interested in a tug of war. Ukraine should be able to choose its own future and act as a bridge between Russia and Europe.
	Britain’s own future depends on a world where countries obey the rules. In Europe, we have spent the past 70 years working to keep the peace, and we know from history that turning a blind eye when nations are trampled over stores up greater problems for the longer term. We must stand up to aggression, uphold international law and support the Ukrainian Government and the Ukrainian people, who want the freedom to choose their own future. That is right for Ukraine, right for Europe, right for Britain. I commend this statement to the House.

Edward Miliband: I thank the Prime Minister for his statement, and I join him in expressing deep concern about the situation in Ukraine.
	Since we discussed this issue in the House last Wednesday, we have seen the illegal referendum announced in Crimea, Organisation for Security and Co-operation in Europe observers prevented from crossing into the region by Russian forces for four days running and, yesterday, violence on the streets against anti-Russian demonstrators. We support the twin-track approach of encouraging dialogue and at the same time maximising pressure on the Russian Government, but nobody looking at the unfolding situation on the ground would conclude that this is yet having the desired effect. It is on that basis that we should examine the discussions taking place, the outcome of the EU summit and the steps that should be taken in the days ahead.
	It is worth saying that getting agreement among the EU 28 is always difficult, particularly when a number of member states are vulnerable to Russian action on issues such as energy. However, as we agreed last week, this is a test of EU resolve and of its commitment to uphold the rule of law, democracy and human rights—values on which it prides itself as an institution.
	Let me welcome the summit measures that were agreed. Those include the unity of the EU in condemning Russia’s actions and the decision to provide support and encouragement to the Ukrainian Government, including €11 billion of aid. The Prime Minister referred to the suspension of visa talks and a new agreement on EU-Russia relations. Those measures are welcome, although they had been announced on 3 March before the developments that I referred to at the start. Does he accept that the evidence from recent days suggests that those measures alone will be insufficient to get Russia to change course, and that further action will be required?
	Turning to what more needs to be done, I welcome the European Council’s decision to look at further measures, although the agreed language is weaker than we would have wished. I welcome what the Prime Minister said about asset freezes and travel bans. Will
	he confirm that the time frame for their implementation will be days and not weeks, particularly given that the United States is committed to such action? On the EU-Russia summit, which is referred to in the Council conclusions, surely it makes sense at the very least, unless there is an immediate change of course by the Russian Government, to suspend preparations for it, as has been done for the G8 summit in Sochi.
	Beyond that, I welcome the Prime Minister’s statement that we need to look actively at other measures. I urge him in the days ahead to build support for further measures among our European and other allies to prepare for the eventuality that they will be required.
	Let me ask the Prime Minister about some specific matters. Will he confirm that, if Russia does not change course, he will consider working with the G7 to suspend Russia from the G8—something that he called for specifically at the start of the crisis in Georgia in 2008? That would go beyond simply withdrawing from the preparatory talks for Sochi or from the Sochi summit itself. Following the announcement that the UK Government are reviewing every outstanding arms export licence to Russia, to which he referred, will he confirm what the time scale is for the conclusions on that issue? What scope does he believe there is for an EU-wide agreement on arms exports?
	Finally, will the Prime Minister not only confirm that he is open to wider economic and trade sanctions, as he said in his statement, but tell the House in what circumstances it would be appropriate to go down that road? He said in his statement, with a reference to Chancellor Merkel, that there would need to be a ratcheting up of pressure on Russia if it used the referendum in Crimea to strengthen its hold on Crimea. Will he say specifically whether economic and trade sanctions would be appropriate in those circumstances, given that the referendum is a pressing matter and will take place in a week or so?
	In conclusion, we should continue to use all possible channels to facilitate dialogue and encourage the Ukrainian Government to be as broad based as possible. We recognise the constraints on the Prime Minister in seeking to reach EU-wide agreement. However, I urge him, particularly as we approach the referendum in Crimea, to apply maximum influence on our allies, so that maximum pressure can be applied on the Russian Government. Hesitancy or weakness in the EU’s response will send precisely the wrong message. The UK has a vital position of responsibility in ensuring that that does not happen and that, instead, the EU and the US stand together in clear and united resolve. We will provide him with all the necessary support as he seeks to achieve that.

David Cameron: I thank the right hon. Gentleman for what he has said. He has welcomed our approach, which is a combination of pressure and dialogue. That is absolutely right: we should be trying to de-escalate the crisis, but an element of deterrence is required to discourage further aggressive steps from Russia.
	Let me try to answer each of the right hon. Gentleman’s questions. He is right that this is a test of European resolve. It is clearly difficult, as he says, to get agreement among 28 countries. There are countries in the European Union that have a heavy dependence on Russian energy, for instance, so we have to try to bring everyone along in
	the argument. That is what happened at the European Council. A lot of people were expecting a strong US response and an EU response that was well behind it. That did not happen. Given everything, the EU response was a relatively good one.
	The right hon. Gentleman asked whether further measures will be needed. That will obviously depend on the Russian response. We are trying to be clear, predictable and consistent in setting out what has been done, what will need to be done if the talks do not get going, and what further steps would be taken if Russia took further aggressive steps, for instance in eastern Ukraine. Setting that out in advance helps people to understand the depth of concern in the EU and the preparedness for action.
	The right hon. Gentleman asked whether asset freezes would be put in place in days rather than weeks. Obviously, that depends on whether the Russians set up the contact group and start the dialogue with the Ukrainian Government. If they do not, asset freezes and travel bans will follow, and yes, that should follow in a matter of days not weeks, because the setting up of the contact group and the starting of talks is not a particularly difficult step for the Russians to take if they genuinely want to see this ended through a process of dialogue, rather than continuing with this conflict.
	The right hon. Gentleman’s comment about linking the EU-Russia summit with the G8 is absolutely right. It would be unthinkable for a G8 not to go ahead while an EU-Russia summit did go ahead; these things have to be considered in tandem. He also asked whether it would be right to resuscitate the G7, rather than going ahead with the G8. If we do not make progress on a contact group and if Russia takes further steps, clearly one of the measures that we could bring forward relatively quickly would be to take a different approach by going back to a G7, rather than holding a G8, but let us hope that that is not necessary.
	In relation to arms, the right hon. Gentleman made the point that we should try to take action across the EU, and I very much agree with that. I have set out today my own view about arms licences from Britain, and we will be working within the European Council to try to achieve the greatest possible common ground on this. The fact is that some countries have substantial exports to Russia, but as I said at the Council, everyone is going to have to consider things that might be painful and difficult for their own country, and I think that the countries concerned are prepared to take those steps.
	The right hon. Gentleman asked about the issue with Crimea, and about what consequences could follow there. It is very clear that the international community is not going to recognise that illegal and illegitimate referendum. As I said, it is a fairly farcical referendum, because people cannot get out and campaign across Crimea. There is not even a proper electoral register there, there are troops all over the territory and Ukrainian politicians are unable to travel from one part of their country to another. So the referendum is clearly not only illegal but rather farcical. Again, the answer lies in Russia’s hand, because this is about how it reacts to this illegal and illegitimate referendum. If it reacts by saying that it is somehow legitimate, consequences should follow from that.
	The right hon. Gentleman asked whether we should put maximum influence on our allies in Europe to try to strengthen these statements and measures, and we will. He made the point that the EU and the US should work
	together, and that is exactly what I believe we achieved last week. Also, behind his questions was the idea that we should be trying strategically to make the European Union member states less dependent on Russia. Some are heavily dependent on it for oil and gas, and it is right that the European Union should spend more time thinking about that.

Peter Tapsell: Why is it acceptable for the Scottish nationalists to be granted a referendum in Scotland on constitutional arrangements dating back to 1707, but unacceptable for Russian nationalists in the Crimea to have a referendum about constitutional arrangements that date back only to 1954? Does my right hon. Friend agree that, if the Crimean referendum could be postponed until such time as international observers could be put in place to ensure that the referendum was genuine, that would be by far the most sensible solution to the problem?

David Cameron: To answer the Father of the House directly, the difference between the Scottish referendum and the one in Crimea is that the Scottish referendum is legal. It was discussed and debated in this House and in the Scottish Parliament, and we went a long way to put in place arrangements that I have described as not only decisive and fair but legal. The difference between those arrangements and the Crimean referendum is that the Crimean referendum is illegitimate and illegal under the Ukrainian constitution. That is not to say that the people of Ukraine or of Crimea cannot, over time, find a way of expressing their own preferences. That is what we have done in Scotland, and of course they can do it there too, but the way in which this referendum has come about is clearly illegitimate and illegal; that is the difference.

Jack Straw: Against the background of thugs in Crimea blocking the admission of OSCE monitors into Crimea, what does the Prime Minister think of Russian Foreign Minister Lavrov’s claim last week that one of the ways of resolving the matter peacefully is by using the OSCE?

David Cameron: The right hon. Gentleman, who served as Foreign Secretary, speaks with great knowledge. The fact is that a number of things our Russian interlocutors have said have turned out simply not to be true. We have to be very clear in challenging them on that. Of course Russia has an interest in having a strong and positive relationship with Ukraine, which we understand and welcome, but in these circumstances some of the things that have been said about what is happening on the ground, the consequences that would follow certain actions, and indeed the point he has just made, show that they have not been entirely straightforward with us.

Martin Horwood: I welcome the steps that have already been taken and the option of much stronger economic sanctions, but the presence of small but visible numbers of neo-fascist thugs on the streets of Ukraine, and indeed on the TV screens of Russia, is clearly just playing into Vladimir Putin’s hands. Can we assist the Government of Ukraine in returning control of law and order on the streets to the regular police as soon as possible?

David Cameron: My hon. Friend is clearly right that in Ukraine, as in all countries, we need to see legitimate forces of law and order—the police and the military—with responsible roles, rather than militias. But I think that we should be very careful not to do what the Russians are doing, which is to exaggerate the claims they are making in order to justify some of their actions. Of course, as I have said, what we need in Ukraine is respect for all minorities and all the different languages, including the Russian language speakers. I am confident that the Ukrainian Government understand that.

Gisela Stuart: I welcome the fact that the Prime Minister has come to the House to make a statement on the European Council, something he has not done quite as assiduously as I think he should have done in the past. Did he have an opportunity to speak in the margin to other NATO members, given that he is preparing for a NATO council in September in Wales? Presumably at that stage article 5 will suddenly have acquired a new pertinence to quite a number of EU member states.

David Cameron: First, I say to the hon. Lady, for whom I have considerable respect, that I think that I have made more statements following European Councils than my predecessors, not least because their number has gone up. Every now and again we make a written statement, but normally we make an oral one.
	Secondly, on the issue the hon. Lady raised, I took the time to speak to as many colleagues as I could, including a number of NATO colleagues. Obviously there is great concern, particularly from our colleagues in the Baltic states and in Poland, and I listened very carefully to what they said. I think that it is very important that we emphasise the security guarantees that NATO provides and that they should have confidence and certainty in them. I think that those countries also speak with great knowledge about what works when standing up to, and being clear about, these threats from Russia.

Nicholas Soames: Although we all want to see the emergence of a reliable new Russia that abides by the rules, does my right hon. Friend agree that, in order to ensure that the costs of standing up to aggression are fully met, we need a serious rethink as we approach the next strategic defence review and the agenda of the NATO summit?

David Cameron: I think that my right hon. Friend is right. All these events should always cause us to look again at our strategy and at the decisions we have made. I think that they emphasise the importance of standing by our NATO allies and strengthening NATO. They also emphasise the importance of dealing with new threats, such as cyber. Obviously we will take all those things into account in the next strategic defence review.

Dennis Skinner: Since the Prime Minister has become an expert on promising referendums on the EU, then postponing them, and then promising another, what right has he to tell Putin that he cannot have one in Crimea?

David Cameron: I think that I answered that question pretty comprehensively in response to my right hon. Friend the Father of the House. Of course, any
	country that wants to can hold a referendum under its constitution—that is what constitutions are able to deliver—but it has to be fair and legal. It is quite clear—everybody agrees, except the Russians—that this referendum is illegitimate, illegal and will not be recognised by the international community.

Richard Ottaway: With the so-called referendum due to be held on Sunday, time is not on our side. Now that Russia is far more integrated into the world economy, the most effective short-term pressure that can be applied is financial and economic, but we should not be looking just at national assets. Does the Prime Minister agree that Russian banks and corporations that are contemplating taking over Ukrainian assets in Crimea should be warned that if they go down that road, they will be denied access to western financial institutions?

David Cameron: My right hon. Friend makes an important point. The three-phased approach sets out that if there are further Russian moves on eastern Ukraine or to further destabilise Ukraine, we as the European Union would be prepared to bring forward a range of economic and other sanctions which, as it states in the European Council conclusions, would cover a broad range of areas. Nothing is off the table. Of course, these things are never easy for democracies to carry out. It was pointed out at the meeting that some countries might suffer more with energy sanctions, some with financial sanctions, and some more with defence sanctions. As the European Union, and as member states, we must consider what steps would be necessary to send a clear message to Russia. My right hon. Friend’s point is a good one.

Chris Bryant: I am glad that the Prime Minister has scotched the idea that some seem to have that it is somehow acceptable for Russia to subsume Crimea on the basis that a majority of Crimeans speak Russian. That is the language of 1938, and it did not do very well for Czechoslovakia in the end. May I urge the Prime Minister to do one thing immediately? The United States of America has already done this, and the European Parliament has called on all countries in Europe to do so, as has the Council of Europe. Will he tell the Russian officials who were involved in the murder of Sergei Magnitsky and in the corruption he unveiled that they are not welcome in this country?

David Cameron: As ever, the hon. Gentleman speaks powerfully about these issues, and those are the sorts of things we can take into account when looking at individuals who will be affected by travel bans and asset freezes. On historical analogies—a number of people are making such points—I think that perhaps the best ones to draw are by looking at what happened to Georgia and the frozen conflicts of South Ossetia and Abkhazia, and in Transnistria. There is a pattern, and we need to interrupt it by the European Union and member states, with our American allies and others, taking a strong stance.

John Redwood: Will the Prime Minister now seek fundamental changes in EU energy policy? Some member states are far too dependent on Russian gas, and the rest of us are far too dependent
	on intermittent, dear and scarce sources of energy, owing to EU directives. Do we not need to get control of our power to be able to reply?

David Cameron: My right hon. Friend is entirely right. Here in the UK, we are not reliant to any significant degree on Russian supplies of gas, but some countries in Europe receive 60% or 70% more of their gas from them. As a European Union we need to think about how to make ourselves more resilient as a group of countries, and part of that will be by completing the European energy single market, which will make a difference to those countries. This is clearly a good moment to press that concern in Europe and get more done.

David Winnick: I happen to believe that there should be a legal and responsible referendum as far as Crimea is concerned—one that is under international control and not the sort of effort the Russians are organising. Whatever views we hold about Crimea, should we not totally condemn what Russia has done? Outright thuggery against part of a neighbouring and sovereign state should certainly be condemned.

David Cameron: The hon. Gentleman is absolutely right, and we should not only condemn the Russian action, but set out the consequences that will follow. On the referendum, a number of Members of this House have taken part in election campaigns and referendum campaigns, and it is worth thinking about how practical it is to hold a referendum between now and Sunday when there is no register, no campaign, and Ukrainian politicians cannot travel round their country. It is not only illegal but literally farcical to think of that going ahead and in any way being respected, responded to, or legitimised by the Russians or anybody else.

Julian Lewis: Have the arrangements we have put in place for the safe withdrawal of troops and especially heavy equipment from Afghanistan by the end of this year in any way been affected by the tension that has arisen between us and Russia?

David Cameron: We have not received any information that would lead us to think that. If we are going to take steps—diplomatically, politically and, potentially, economically—we should take them because it is the right thing to do. We should recognise that there may be consequences from some of those things. There could be consequences for the City of London and some European defence industries, or for energy or other interests around Europe. However, we should proceed knowing that what we are doing is sensible, legitimate, proportionate, consistent and right.

Keith Vaz: I welcome the Prime Minister’s commitment to sign the association agreement before the elections on 25 March. A poll of Ukrainians last year showed that the vast majority want to be members of the EU. Were there any discussions about Ukraine joining the EU as a candidate country, because that could provide focus for the Ukrainians at this time of instability?

David Cameron: I have great respect for the right hon. Gentleman. There were no discussions on Ukraine’s long-term aims to join the EU. The discussion was
	about what progress we could make on the association agreement. It was an important debate, because European colleagues felt strongly that we could not indicate that we would have been happy to sign an association agreement with the previous President but hold back from signing one with the current Administration. We therefore came forward with the idea of signing the political part of the association agreement, lowering European tariffs as a unilateral gesture to help the Ukrainian economy, and pressing ahead with the rest of the agreement in a proper time frame.

Jake Berry: My right hon. Friend has spoken of the inability of Ukrainian politicians to campaign on the Crimea. Will he confirm that a referendum scratched together in 10 days at gunpoint at the behest of a foreign power can never be regarded as legitimate, fair or free?

David Cameron: My hon. Friend puts it extremely well. The referendum is obviously not free, fair or legitimate, and we should have no hesitation in saying so.

Jeremy Corbyn: A week ago, the Foreign Secretary assured the House that there was no question of Ukraine joining NATO. Since then, we have had a steady stream of statements from the NATO Secretary-General, who has spoken at great length and expansively of expanding NATO and once more getting very close to Russia. Does the Prime Minister believe that the NATO Secretary-General should calm down a bit, and that there should be less talk of expansion, to try to de-escalate the tensions rather than increase them?

David Cameron: Ukrainian membership of NATO is not on the agenda at present, but it is absolutely right that NATO countries are responding as strongly and as clearly to the threat of Russian aggression and destabilisation as they are. We should listen particularly to countries such as the Baltic states and Poland that wanted to join NATO. We made absolutely the right decision to allow them to do so.

Penny Mordaunt: Does my right hon. Friend agree that accepting a Russian seizure of part of Ukraine is against the national interests of the UK?

David Cameron: My hon. Friend makes an important point. We should define what our national interest is in this instance, and I think it is that Britain benefits from there being a world where countries obey the rules and where there is a rules-based global system. We are an international country—a country that relies on the world’s markets being open, and on countries obeying norms and standards of behaviour. We know what price is paid if we turn a blind eye when such things happen: we build up much bigger problems for the future.

Pat McFadden: At the critical moment a few weeks ago, and during the street protests in Kiev, the Foreign Ministers of Germany, France and Poland represented the European Union. Why was Britain absent from that group? Was it a deliberate choice of the UK Government, or was it a reflection of our threat to leave the European Union in three years’ time?

David Cameron: We strongly supported the work that the Foreign Secretaries of Poland, Germany and France did. They had the strong support of the UK Foreign Secretary, who was in Brazil at the time of that meeting. That meeting was important, but if anyone wants to say that Britain has somehow not played a leading role in bringing together international action on the crisis, they would have quite a hard argument to make. The Foreign Secretary was the first leading politician to get to Kiev and listen to the politicians themselves after the events. We helped to co-ordinate that important EU statement, and we are helping to bring the United States and the EU together on a concerted set of actions. I commend all the work my Foreign Secretary has done.

Tony Baldry: I refer to the answer to our right hon. Friend the Member for Wokingham (Mr Redwood). Does the Prime Minister agree that recent events demonstrate the need for the UK to be as energy self-sufficient as possible, to maximise the returns from North sea oil and gas, and to utilise fully the potential of UK fracking to help ensure that the UK can be as energy self-sufficient as possible?

David Cameron: My right hon. Friend makes a strong argument. Britain has a diverse source of energy supplies—we have North sea oil and gas, we have long-term supply contracts with countries such as Qatar, we have our nuclear industry which we are now reinvigorating, and a large investment in renewables. One of the arguments that colleagues were making at the European Council was that we should encourage the US to start exporting some of its gas. That would be hugely beneficial and something that we should support, but in my view it raised the question why the European Union is not doing more to support and promote recovering unconventional gas. We should be doing that ourselves in order to enhance our energy security, and that goes for all the countries of the European Union.

Helen Goodman: Can the Prime Minister tell the House what the international community might do to protect the Crimean Tatars? By the same token, what message have the British Government given to the new Ukrainian Government about the protection of Russian minorities?

David Cameron: The hon. Lady makes an important point. In all our dealings with the Russians and with the new Ukrainian Government, we have set out the importance of making sure that the new Ukrainian Government are inclusive and that the Ukrainian elections give proper rights to minorities and to Russian speakers. As I say, we emphasised that point to the Russians as well, and obviously the Tatars in Crimea are a case in point.

Bernard Jenkin: I join my right hon. Friend in his condemnation of Russian action and duplicity in Ukraine. How does he think the west can help de-escalate, given that Ukrainian society is deeply divided and the present Government represent only one faction and are unelected? Should we not call for new elections in Ukraine—the election of a national Government—and should we not take the EU association agreement off the table as an unnecessary provocation in the current situation?

David Cameron: The best way that Britain can help to de-escalate this crisis is by encouraging a talks process. That is why we came up with the idea of a contact group to help Russia and Ukraine talk each other in the company of important European powers and organisations, and that is what we should push very hard. However, I take issue with my hon. Friend’s description of the Ukrainian Government. The Ukrainian Parliament had to react to the fact that the President left the country, and it took constitutional steps to put a transitional Government in place. That transitional Government have said it is important to respect the rights of Russian speakers and minorities, and they have had that point put to them by others as well. I do not think it is fair in any way to blame the European Union for this crisis. The European Union rightly has partnership and neighbourhood approaches to its neighbours but these are voluntarily entered into, and it is right that the European Union has those arrangements.

Pete Wishart: I thank the Prime Minister for his statement and early sight of it. Notwithstanding his response to the right hon. Member for Blackburn (Mr Straw), does he share my disappointment at the way the OSCE has been treated and prevented from carrying out an important task on the ground? What extra support can the UK Government give the OSCE to ensure that it does that vital task?

David Cameron: We will keep supporting the OSCE in the work that it does. The hon. Gentleman is right that the way potential observers and observer missions have been treated is appalling. They should be there; they play a vital role. We will do everything we can to support them. The fact that they are not being allowed in is a material consideration in thinking about the steps that we take next.

Several hon. Members: rose—

Mr Speaker: Order. The hon. Member for The Wrekin (Mark Pritchard) has perambulated across the Bench from its middle to its end. Some people might think it is almost as difficult for me to keep an eye on him as it is for the Government Whips. I call Mr Mark Pritchard.

Mark Pritchard: I have a Panel of Chairs meeting to attend—I am grateful for being appointed to the panel.
	Instead of listening to the criticism of some Opposition Back Benchers, the Prime Minister should be commended not only for his statement but for his leadership on this issue in Europe along with the Foreign Secretary. On the issue of European unity, is it not the case that while Germany, Hungary and the energy axis aligned with Russia might agree on phase 1 on the European strategy, phases 2 and 3 may be more challenging?

David Cameron: I am grateful for what my hon. Friend says. All those countries—Hungary included—signed up to the European Council conclusions that were extensively debated around the table at that meeting, so they are committed. It states clearly that if further steps are taken to destabilise Ukraine, the European Union will take steps covering a range of economic areas. Nothing is ruled out from those areas. Yes, it
	will be difficult, but I am confident that were that eventuality to come to pass, we would be able to respond appropriately.

Alison McGovern: Further to the point made by my right hon. Friend the Leader of the Opposition and the right hon. Member for Croydon South (Sir Richard Ottaway), it is good to hear the Prime Minister talk about asset freezes. He said in his statement that the Council has asked the European Commission to begin work on these additional measures. What work will the UK Government do to support the Commission in that, and what conversations has he had with our European partners on this specific subject?

David Cameron: We will hold a meeting tomorrow that will include representatives from the European Commission and from Britain, to go through and look in detail at which individuals could potentially be named. There should be maximum co-operation between the various European countries and European organisations about this.

Crispin Blunt: Europe is littered with potential conflicts like that now afflicting Crimea. Is my right hon. Friend clear that the security of the whole of Europe depends on countries obeying the rules in this area, and while Russia remains outside those rules, she must be made to pay a very serious economic price?

David Cameron: My hon. Friend is right. As I have said, we have these frozen conflicts that we still struggle with across Europe. We are making a concerted effort to ensure that this does not turn into another one. We have to accept that there will be real and quite painful consequences for European countries if we have to go ahead with sanctions, but we should do so because it would be a greater evil to allow this situation to continue.

Dave Watts: Has the Prime Minister carried out any review of whether Russians are already moving their assets outside the UK before any freeze is introduced?

David Cameron: I have not seen any evidence of that. Sometimes the City of London is unfairly painted as somewhere that does not have tough rules on money laundering. It does. It is painted as somewhere that does not have tough rules on transparency. It does. Part of the G8 agenda was aimed at making sure that we get greater transparency, particularly on issues such as tax. We will take the necessary steps, if that becomes appropriate, and the City of London will play its full part.

Bob Stewart: The Baltic republics border on Russia and they have substantial Russian populations. My right hon. Friend has already hinted that they must be somewhat nervous. They are NATO members, so does he think it appropriate that NATO should reaffirm the principle of collective security for all its members?

David Cameron: The collective security approach is at the heart of NATO, and we should reaffirm it every time NATO countries meet. Looking back, was it right to allow Latvia, Lithuania, Estonia, Poland and other
	countries to join the European Union and NATO? Yes, it was. It gave them the security and stability to make economic progress, combat corruption and have the sort of free and open societies that the House supports. They draw a lot of strength and succour from that, and we should not forget it.

John Woodcock: The Prime Minister is right to say there is a pattern to President Putin’s aggressive expansionism. Is the right hon. Gentleman not concerned that the measures he has committed to, or set out as possibilities, may prove insufficient to disrupt that pattern? Will we not look back with great regret if this emboldens Russia to continue on this path, potentially to the door of NATO members themselves?

David Cameron: If we pursue the steps we are contemplating and the steps the EU has agreed to take in a strong, predictable and consistent way, we can demonstrate to Russia that there is a pathway where it chooses dialogue and diplomacy to settle these issues, rather than further destabilisation. That would be the right outcome. I do not think that this approach is doomed not to work, for the simple reason that there are long-term costs to Russia in not recognising the importance of its economic and diplomatic relationship with Europe. For instance, we talk a lot about Russian gas. Yes, Europe is reliant on Russian gas to the tune of 25% of the EU market as a whole, but approximately 50% of Gazprom’s sales are to Europe. There are, therefore, strong arguments to say that Russia needs a sensible relationship with Europe more than Europe needs a sensible relationship with Russia. We should not talk ourselves down in any way. If we are tough, predictable and consistent we can help to emphasise to Russia that she should choose a path of diplomacy, not conflict.

Geoffrey Clifton-Brown: Does my right hon. Friend agree that one of the excuses for President Putin unleashing his troops in Crimea was that he wanted to protect the Russian minorities? When the Prime Minister next contacts the Ukrainian interim Prime Minister, will he urge him to broadcast and do whatever he can to promote an inclusive message to every citizen of Ukraine that they have nothing to fear from him, either as an interim Government or as an elected Government, and will he also urge the BBC to broadcast that inclusive message?

David Cameron: My hon. Friend makes a very good point, which is that we should keep saying to the interim Ukrainian Government, and indeed to any new elected Ukrainian Government, that they should respect the rights of minorities and the rights of Russian speakers. We should also uncover how much of the propaganda we have been told about these sorts of things is made up, exaggerated and fabricated. We must not let the Russians get away with a propaganda campaign that says that were it not for the action of Russian troops in Crimea there would somehow have been an appalling bloodbath. I do not think that that is the truth at all, and we should challenge that at every opportunity.

Cathy Jamieson: The Prime Minister made reference in his statement to the importance of stabilising the new Ukrainian
	economy, and to the role of the EU and the International Monetary Fund. Can he give us more information on when the EU will be bringing forward a clear timetable and the milestones for the release of the financial assistance package?

David Cameron: The hon. Lady asks a very important question. The EU, rightly, is being guided by the IMF team in Ukraine. The IMF has the real expertise on what is needed in terms of conditions, guarantees and undertakings on economic reforms to release an IMF programme. The majority of the EU money is conditional on that IMF programme going ahead.

Andrea Leadsom: Has the Prime Minister been able to assess reports that up to £100 billion was stolen by the previous Ukraine regime? What steps is the EU Council making to try to retrieve that money? Do we need more international action to ensure that offshore banks take very seriously their duty to check where money is coming from to avoid authoritarian regimes impoverishing their countries?

David Cameron: My hon. Friend’s point is absolutely key. As I said in the House last week, the reaction of the Ukrainian people against their former President was as much about being against corruption, and the massive larceny that has taken place on an industrial scale in that country, as it was about making a statement on whether to move closer to Europe or in another direction. I have seen reports of vast sums and figures. We should redouble our commitments to get to the bottom of whether we can recover any of the stolen money and return it to the Ukrainian people. In our international and diplomatic work, and in our aid work, we should redouble our efforts to tackle corruption right across the world.

John Cryer: The Prime Minister will be aware that the European Union consistently supported the breakaway of Kosovo from Yugoslavia. Does that not hand a fairly useful argument to Russia, which will deploy it consistently with regard to Crimea?

David Cameron: Obviously the Russians do use that argument, and we hear it frequently. The events to which the hon. Gentleman has referred happened under an earlier Government, but the point that I would make, very much in their defence, is that there was a clear and present danger to the Kosovans who lived in Serbia. There was a real danger there, and we had to act in order to avert it. The steps that have been taken from that point onwards have been taken in a very deliberate and consistent way.

Neil Carmichael: I noted the Prime Minister’s earlier answers in connection with energy. Does he agree that Britain could make a really important contribution by encouraging other nation states to be as liberal and competitive as possible in relation to energy, in order to strengthen his case for saying that Russia needs Europe more than Europe needs Russia?

David Cameron: My hon. Friend has made an important point. If countries liberalise and open up their energy markets, they can secure greater diversity
	of supply, greater competition, and unbundling between producers and distributors, all of which can help to provide a more resilient set of energy conditions. We are encouraging such action throughout Europe, not least through the completion of the energy single market.

Gemma Doyle: Last week the Foreign Secretary said that the chances of the United Kingdom signing a multi-technical co-operation agreement with Russia were now greatly reduced. The Prime Minister says that he wants to be tough. Is he now going to rule out the signing of that agreement?

David Cameron: As I have said, we are reviewing all our military co-operation with Russia. Obviously, the arrangements that we will want to continue are those linked to international arms agreements, inspections and the like, but I think that there will be an increasingly strong case for cancelling other arrangements. I repeat that I think that it is worth our doing this in conjunction with other European Union member states. I think that we maximise our influence and leverage in this regard if we act together, and I am keen that we should do so.

Edward Leigh: The Prime Minister is right to stress the importance of history. For instance, ultra-nationalist Lviv was once 80% Polish Lvov, and before that was Lemberg in the Austro-Hungarian empire. I wonder whether the Prime Minister—with his well-known charm, diplomatic skills and all the rest, and with no obvious self-interest, as a Briton—can act as a bridgehead between those in the European Union who want to alarm Russia by detaching Ukraine from traditional spheres of influence and Russian imperialists. I should have thought that he could play a very useful role in promoting diplomacy and good relations.

David Cameron: I am very grateful for my hon. Friend’s suggestion. I have spoken to President Putin, I think, four times since the crisis began, and one of the points that I always make is that Britain understands—and I think many in the European Union understand—that Russia has a very close interest in what happens in Ukraine, and wants to have a strong relationship with it in the future. The point that I make—and tried to make in my statement—is that this should not be a tug of war between Russia and Europe, but should be a chance for the Ukrainian people to decide their own future. They could easily choose a future in which they act as something of a bridge between Europe and Russia, and we should be actively encouraging that. We should be saying to the Russians, “Of course we want a Ukraine where Russian speakers and minorities are properly treated, and a Ukraine which has a proper relationship with both Russia and the European Union.”

Nicholas Dakin: Can the Prime Minister comment on whether his party is still sitting in the same political grouping as President Putin’s United Russia in the Parliamentary Assembly of the Council of Europe? If it is—and it may well not be—what is he going to do about it?

David Cameron: I can satisfy the hon. Gentleman by saying that that is no longer the case.

John Baron: Events in Crimea are reminding us yet again that powerful countries which are not necessarily friendly to the west
	are not only increasing their defence spending, but are prepared to project their capability. Was there any discussion, or indeed recognition, in the European Council of the need to raise defence spending from its present low levels?

David Cameron: We were very much discussing the diplomatic, political and economic steps that needed to be taken, rather than any military steps, but I agree with my hon. Friend that it is important for us to maintain a proper level of defence spending. Britain has one of the top five defence budgets anywhere in the world. However, I think that even more important than the amount of money that we spend are the capabilities that we buy with that money. It is very important for us to modernise the way in which we spend our money, and we should encourage all European countries to do that as well.

Debbie Abrahams: I appreciate that last week the UN special envoy to Ukraine ran into some difficulties, but what discussions have taken place about the UN’s role in the escalating crisis in Crimea?

David Cameron: It is important that the UN is at the centre of this, not least because it makes it even more difficult for the Russians to slide away from their responsibilities—they often appeal to the UN and cite the UN charter when making their arguments. Therefore, the UN should be part of the contact group that would include the EU, the United States and European countries such as the UK. In that way, the UN can play a major role in helping to pursue a path of talks and diplomacy, which is the right way to de-escalate the conflict.

Henry Smith: Obviously, the EU Council meeting was dominated by events in Crimea, but on a related matter can the Prime Minister update the House on the association agreements with Georgia and Moldova?

David Cameron: We want to see these association agreements proceed. As I said in answer to an earlier question, the EU has different instruments for having friendly relations with neighbours and other nearby countries. It is right to pursue those and to offer such agreements, so on all those cases we should see progress. As was the case with Ukraine, we should not sign these agreements without thinking carefully about the steps that we expect the countries to take at the same time.

Nick Smith: Given that OSCE observers have been prevented from crossing into Crimea by armed men, what steps is the Prime Minister taking to persuade President Putin to agree the mandate for the OSCE’s monitoring mission?

David Cameron: I spoke to President Putin most recently on Sunday morning. One of the points I made to him was the importance of ensuring that the OSCE is properly handled and allowed to continue its missions. This is part of the argument we need to have with the Russians about how to get off the track that they are on and to get on a diplomatic, political and talks track. The OSCE, which is an organisation they respect, should be part of that.

Charles Hendry: The Prime Minister will be aware that, as a result of the policies he has put in place, our trade with Russia has grown dramatically in recent years and there are now over 600 British companies operating in Russia. Does he agree that, even in times of political stress, it should be a last resort to jeopardise those links, not just because of their economic importance but because they are a vital way of improving understanding between our countries?

David Cameron: My hon. Friend makes an important point. I support a good relationship between Britain and Russia and have taken steps as Prime Minister to try to put that in place. We have huge issues and difficulties between us still, not least the Litvinenko measures that remain in place, and clearly this is going to be a major impediment to a strong relationship between Britain and Russia, unless Russia takes the diplomatic path. We should hope that it does and work towards encouraging it to do so. If that happens, I see no reason why important economic relations, as we have discussed, could not continue.

Mark Lazarowicz: Is it not important to emphasise time and again that to divide Ukraine simplistically into Russian-speakers and Ukrainian-speakers is not a representation of the true situation? There are communities, families and individuals who are both Ukrainian and Russian-speaking. It is important to recognise the rights of minorities across Ukraine and to recognise the rights of different regions, but is not that intermingling of culture and languages a reason why there needs to be a commitment to a united and independent Ukraine?

David Cameron: I echo every word that the hon. Gentleman has said. It is important to recognise how many Russian speakers in Ukraine have said that they support a strong and independent Ukraine and do not welcome Russian intervention. As I have said, we should not fall into the trap of believing a lot of the Russian propaganda—a lot of what we have heard has turned out to be just that.

Richard Drax: I congratulate my right hon. Friend and the Foreign Secretary on all they have done. As I see it, the key is the port of Sebastopol. If Ukraine continues to look to the west, how do we square that circle with the Russians, who have concerns about its use and access to the Mediterranean?

David Cameron: The point I would make, and indeed have made, to President Putin is that a proper, independent, prosperous Ukraine will want to emphasise its links and relationship with Russia as much as its links and relationship with the EU. Clearly, there were pre-existing agreements in place for the Russians to have their Black sea port in Crimea and there is no reason why those things should not continue. What we need to get back to, as I have said, is a diplomatic track where Ukraine and Russia can have sensible conversations about the future.

Stephen McCabe: Further to the question of my hon. Friend the Member for West Dunbartonshire (Gemma Doyle), does the Prime Minister not think it might be more reassuring for the British
	public if he were completely to rule out any sharing of military and technical information with the Russians for the foreseeable future?

David Cameron: I think I have given a fairly clear answer, which is that we are reviewing all the military relations and contacts between Britain and Russia. I have said that export licences for anything that could be used in Ukraine would obviously be very difficult to justify and that we should continue with the military co-operation where it is about, for instance, inspections mandated under international treaties. I have also said that we should take this area of military co-operation and, with our European Union partners, try to agree on a set of principles that would follow as part of either phase 2 or phase 3, as I set out.

Rehman Chishti: I very much welcome the statement by the Prime Minister. Russia is a member of the United Nations Security Council and it is violating the UN charter by violating another country’s sovereignty. Russia has also in the past vetoed United Nations humanitarian action around the world. Is it the right time to look at reforming the UN Security Council and its vetoing system?

David Cameron: My hon. Friend raises a subject that can get diplomats talking for ever and ever, possibly without a conclusion. I think that what this demonstrates is the need to consider at the UN Security Council resolutions that may require Russia to show her colours in this regard. I remember a number of occasions when Russia, and indeed China, have talked about the importance of non-interference in the affairs of another nation state, yet what we see here is interference in the affairs of another sovereign nation state, Ukraine.

Andrew Love: Further to the Prime Minister’s response to my hon. Friend the Member for Kilmarnock and Loudoun (Cathy Jamieson) on the International Monetary Fund, Ukraine is facing economic collapse, and Gazprom is threatening to cut off gas supplies. There is an urgency that does not seem to be recognised in the IMF timetables. What efforts are the Prime Minister and the EU making to get it to address the urgent need for financial assistance?

David Cameron: The hon. Gentleman makes an important point and I discussed this specific issue with Chancellor Merkel last night in Hanover. The IMF has the ability to move very quickly, should it judge it necessary, to support Ukraine’s economy and national finances. There is a team there at the moment which is looking at the sort of programme that could be put together, but even before a programme becomes deliverable, if it needs to step in and act faster, it can.

Christopher Pincher: My right hon. Friend is absolutely right to say that Russia’s
	energy supplies give it tremendous muscle in eastern Europe and in other parts of Europe too. That has been reiterated many times this afternoon. Specifically, over the medium term will he encourage the development of the southern corridor gas and oil pipelines from the south Caucasus across Turkey and into southern Europe—pipelines promoted by BP, which will go a long way to helping to develop diversification of Europe’s energy landscape?

David Cameron: My hon. Friend makes a very important point. Diversifying Europe’s energy supplies requires looking at what action we can take to link Europe to some of the supplies in the Caucasus. I remember discussing this issue with President Aliyev when I met him recently, and I know the Foreign Secretary has had those discussions as well. This is part of a larger pattern of diversifying Europe’s energy supplies and making us more resilient in this sort of situation.

Andrew Gwynne: Further to the question asked by my hon. Friend the Member for Edmonton (Mr Love), Gazprom has already warned Ukraine that it may cut off gas exports unless it pays back the $1.89 billion debt it owes. Surely now is the time for the timely transfer of financial support to allow Ukraine to pay off that debt to prevent a repeat of 2009, but what contingency plans are in place should that not happen?

David Cameron: Clearly, Ukraine needs to pay its bills, as well as paying its pensioners and funding its Government to ensure—[Interruption.] I know that the hon. Member for Bolsover (Mr Skinner) misses the old days of the Soviet Union, but perhaps he will stop speaking from a sedentary position for five minutes. It is important that Ukraine pays its bills, and an IMF programme and IMF action can help that to happen.

Huw Irranca-Davies: Sometimes it is the weight of small diplomatic acts, as well as the large, that make a breakthrough that can help. Back in 2008, the Prime Minister, then the Leader of the Opposition, made the bold pledge to withdraw his MPs, as well as, I hope, the people who sit in the other place, from the European Democrat Group in the Parliamentary Assembly of the Council of Europe, following the invasion of Georgia. Is it now right to think about membership of that group again, following the issues in Ukraine and Crimea?

David Cameron: It just shows that in politics, even if you give a straight answer to a straight question, you can still get the question again. I thought I said a minute ago that we have made sure that the Russians are out of the group that we sit in as part of the Council of Europe. We have taken that step, which is the right step. There may be steps for other political parties to think about taking now.

Points of Order

Pete Wishart: On a point of order, Mr Speaker—

Mr Speaker: I was about to thank the Prime Minister and the 47 Back Benchers who questioned him, in 47 minutes of exclusively Back-Bench time, which shows just what we can do when the questions and answers are pithy. But things would not be complete without points of order.

Pete Wishart: I am grateful, Mr Speaker. Last Thursday, the Secretary of State for Defence made a statement on the radiation leak at the Government’s Vulcan nuclear reactor test establishment at Dounreay. He said that
	“there has been no measurable change in the radiation discharge.”—[Official Report, 6 March 2014; Vol. 576, c. 1085.]
	We have since learned that all the environment agencies throughout the UK have found a tenfold increase in radioactive emissions. Clearly, both cannot be right. Have you had any indication, Mr Speaker, whether either the Secretary of State or the Prime Minister will come forward to put the record straight? If it is the Prime Minister, may we also have an explanation as to why Scottish Ministers were not told and perhaps even an apology for that omission?

Mr Speaker: The short answer is that I have had no indication from any Minister of an intention to make a statement on this matter. Whether intentions will change on the back of the hon. Gentleman’s observations, I leave time and speculation by colleagues to reveal. We will leave it there for today, but the hon. Gentleman has put his point on the record.

Edward Leigh: On a point of order, Mr Speaker, I hope you will not mind me sucking up to you for a bit. In my view, you are one of the best Speakers that we have had in recent years, because you have tried to make this place more topical. We have had an interesting statement and questions on Ukraine, but such issues are complex, and it is hard to express difficult economic and historical arguments in a 30-second question. As we have a House of Commons in which we are not overburdened with work at the moment, will you use your good offices with those who decide things—I do not know how much power you have—to get a full day’s debate on Ukraine, which after all is an extraordinarily important issue that we need to discuss urgently?

Mr Speaker: I am grateful to the hon. Gentleman for his point of order and for his characteristic good humour in putting it. As he knows, that is not a matter for the
	Chair. The Government Chief Whip is present, but at least as importantly the Leader of the House is also present.
	As colleagues know and as people who attend our proceedings appreciate, I am the servant of the House. I love listening to my colleagues on matters of local, national and global importance. My appetite for listening to them is pretty much unlimited. I would love there to be a full day’s debate and I would love to be in the Chair to hear the bulk of it, but I am dependent on a superior power in these matters, namely the Leader of the House. The hon. Gentleman, however, has made his point, and the Leader of the House cannot fail to have heard his point and my response. As for the response of the Leader of the House, it has to be said that it should probably be best described by Hansard as impassive.

Andrew Lansley: indicated assent.

Mr Speaker: He nodded.

CARE BILL [LORDS] (PROGRAMME) (NO. 2)

Ordered,
	That the Order of 16 December 2013 (Care Bill [Lords] (Programme)) be varied as follows:
	(1) Paragraphs (5) and (6) of the Order shall be omitted.
	(2) Proceedings on Consideration shall be taken in the order shown in the first column of the following Table.
	(3) The proceedings shall (so far as not previously concluded) be brought to a conclusion at the times specified in the second column of the Table.
	
		
			 Table 
			 Proceedings Time for conclusion of proceedings 
			 New Clauses and new Schedules relating to Part 1, amendments to Part 1 7.00pm on the first day 
			 New Clauses and new Schedules relating to Part 2, amendments to Part 2 9.00pm on the first day 
			 New Clauses and new Schedules relating to Chapter 4 of Part 3, amendments to Chapter 4 of Part 3, new Clauses and new Schedules relating to Part 4, amendments to Part 4, new Clauses and new Schedules relating to Part 5, amendments to Part 5, remaining proceedings on Consideration 6.00pm on the second day 
		
	
	(4) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at 7.00pm on the second day.—(Norman Lamb.)

Care Bill [Lords]

[1st Allocated Day]

Consideration of Bill, as amended in the Public Bill Committee

New Clause 1
	 — 
	Adult safeguarding access order

‘(1) An authorised officer may apply to a circuit judge authorised by the Court of Protection for an order (an adult safeguarding access order) in relation to a person living in any premises within a local authority’s area if the authorised officer has reasonable cause to suspect a third party is preventing access to allow enquiries to be made under section 42.
	(2) The purposes of an adult safeguarding access order are—
	(a) to enable the authorised officer and any other person accompanying the officer to speak in private with a person suspected of being an adult at risk of abuse or neglect;
	(b) to enable the authorised officer to assess the mental capacity of a person suspected of being an adult at risk of abuse;
	(c) to enable the authorised officer to ascertain whether that person is making decisions freely; and
	(d) to enable the authorised officer properly to assess whether the person is an adult at risk of abuse or neglect and to make a decision as required by section 42(2) on what, if any, action should be taken.
	(3) While an adult safeguarding access order is in force, the authorised officer, a constable and any other specified person accompanying the officer in accordance with the order, may enter the premises specified in the order for the purposes set out in subsection (2).
	(4) The authorised circuit judge may make an adult safeguarding access order if satisfied that—
	(a) the authorised officer has had regard for the general duty in section 1 (Promoting individual wellbeing) in making a decision under subsection (1);
	(b) all reasonable and practicable steps have been taken to obtain access to a person suspected of being an adult at risk of abuse or neglect before seeking an order under this section;
	(c) the authorised officer has reasonable cause to suspect that a person is an adult who is experiencing or at risk of abuse or neglect;
	(d) the authorised officer has reasonable cause to suspect that a person is unable to make decisions freely;
	(e) it is necessary for the authorised officer to gain access to the person in order to make the enquiries needed to inform the decision required by section 42(2) on what, if any, action should be taken;
	(f) making an order is necessary in order to fulfil the purposes set out in subsection (2);
	(g) exercising the power of access conferred by the order will not result in the person being at greater risk of abuse or neglect; and
	(h) all reasonable and practicable steps have been taken to serve notice of the intention to apply for an order on—
	(i) the person suspected of being an adult at risk of abuse or neglect; and
	(ii) any relevant third party who the authorised officer has reasonable cause to suspect is preventing access to allow enquiries to be made under section 42 and for the purposes set out in subsection (2);
	(5) An adult safeguarding access order must—
	(a) only be executed once;
	(b) specify the premises to which it relates;
	(c) provide that the authorised officer shall be accompanied by a constable; and
	(d) specify the period for which the order is to be in force.
	(6) An adult safeguarding order may attach other conditions, including—
	(a) specifying restrictions on the time that the power of access conferred by the order may be exercised;
	(b) providing for the authorised officer to be accompanied by another specified person;
	(c) requiring notice of the order to be given to the occupier of the premises and to the person suspected of being an adult at risk of abuse; or
	(d) such other conditions at the authorised circuit judge deems it necessary to attach.
	(7) A constable accompanying the authorised officer may use reasonable force under section 117 of the Police and Criminal Evidence Act 1984 if necessary in the circumstance in order to fulfil the purposes of an adult safeguarding access order set out in subsection (2).
	(8) On entering the premises in accordance with an adult safeguarding access order the authorised officer must—
	(a) state the object of the visit;
	(b) produce evidence of the authorisation to enter the premises; and
	(c) provide an explanation to the occupier of the premises of how to complain about —
	(i) the decision to apply for an order; and
	(ii) how the order has been exercised.
	(9) In this section “an authorised officer” means a person authorised by a local authority for the purposes of this section.
	(10) Regulations may set restrictions on the persons or categories of persons who may be authorised.
	(11) Subsections 2(c) and 4(d) refer to a person under constraint, or subject to coercion or undue diligence, or for some other reason deprived of the capacity to make the relevant decision or disabled from making a free choice, or incapacitated or disabled from giving or expressing a real and genuine consent.’. —(Paul Burstow.)
	Brought up, and read the First time.

Paul Burstow: I beg to move, That the clause be read a Second time.

Mr Speaker: With this it will be convenient to discuss the following:
	New clause 2—Review of the case for establishing a commissioner for older people in England
	‘(1) The Secretary of State shall establish an independent review of the case for establishing a statutory office of Commissioner for Older People in England.
	(2) The review will consider the—
	(a) increasing diversity of the older population in England;
	(b) UN Principles for Older Persons in 1991 (UN 1991) and other relevant developments in international policy on ageing;
	(c) lessons from the establishment of such offices in Wales and Northern Ireland;
	(d) balance of advocacy, investigatory and enforcement duties and powers to be granted to the office in statute;
	(e) jurisdiction of the office in relation to other public bodies;
	(f) relationship of the office to Ministers;
	(g) accountability of the office to Parliament;
	(h) appointment of the office holder;
	(i) human and financial resources necessary to support the office; and
	(j) any other matters the Secretary of State sets out in the terms of reference of the review.
	(3) The review will report and make recommendations to the Prime Minister, Deputy Prime Minister, Chancellor of the Exchequer and the Secretary of State by December 2014.’.
	New clause 3—Duty to identify carers
	‘Each NHS body in a local authority’s area, as defined in section 6(8), shall co-operate with the local authority to ensure that effective procedures exist to identify patients who are or are about to become carers and make arrangements for carers to receive appropriate information and advice.’.
	New clause 4—Local authority duty to make reasonable charges
	‘Where a local authority that meets an individual’s needs under sections 18 to 20 of Part 1 of this Act is satisfied that the individual’s means are insufficient for it to be reasonably practicable for the individual to pay the amount which would otherwise be charged, the authority shall not require the individual to pay more for it than it appears to them that it is reasonably practicable to be paid.’.
	New clause 5—Portability of care
	‘(1) The Secretary of State must prepare a report containing an assessment of what primary or secondary legislation would be required to ensure people in receipt of care and support in the community in the UK receive continuity of such care and support if they change their place of residence, with particular reference to moves between countries of the United Kingdom.
	(2) The report under subsection (1) must be laid before each House of Parliament six months after this Bill receives Royal Assent.’.
	New clause 7—Independent review of future demand for social care and healthcare
	‘(1) The Secretary of State shall make arrangements for an independent review of, and report on, the likely demand for adult social care, public health and healthcare services in England over the next twenty years.
	(2) The objective of the review mentioned in subsection (1) shall be to identify the key factors determining the financial and other resources required to ensure that social care and health functions as a cost effective, high quality, equitable, integrated and sustainable single system which—
	(a) promotes individual well-being (as defined in Part 1 of this Act),
	(b) enables access to be determined on the basis of need, and
	(c) can meet forecast demand.
	(3) The arrangements for the conduct of review shall include provision for a fully integrated modeling and analysis of health and social care including examination of—
	(a) the technological, demographic and health status trends over the next two decades that may inform or affect demand for adult social care and health services;
	(b) the inter-dependencies between adult social care, public health and healthcare and the appropriate balance between different types of intervention, in particular between:—
	(i) health and social care,
	(ii) primary and secondary care,
	(iii) physical and mental health, and
	(iv) treatment and prevention; and
	(c) any other matter that the Secretary of State sets out in the review‘s terms of reference.
	(4) The Secretary of State shall lay before each House of Parliament a copy of an interim report on emerging themes and trends identified by the first such review by the end of November 2014 and make arrangements for a consultation process to be undertaken in relation to those interim findings.
	(5) The Secretary of State shall lay before each House of Parliament a copy of the final report by the end of July 2015.
	(6) At no more than five year intervals, the Secretary of State shall make arrangements for the updating of the report of the review mentioned in subsection (1) with the same objective and approach as mentioned in subsections (2) and (3), and including such matters as are provided for in paragraph (3)(c), and shall prepare and lay before each House of Parliament a report on the outcomes.
	(7) The Secretary of State shall prepare and lay before each House of Parliament, as appropriate, a statement on the extent to which the reports mentioned in subsections (1) and (6) inform the Government‘s wider fiscal and economic strategy and decisions in each public spending review.’.
	New clause 9—Reporting on the funding for new costs arising from the Care Act
	‘(1) The Joint Care and Support Reform Programme Board must inform the Secretary of State by an annual written report that it is satisfied whether sufficient funding is in place to ensure that social care is adequately funded and that the provisions in the Act can be implemented satisfactorily.
	(2) In subsection (1), the “Joint Care and Support Reform Programme Board” means the board of that name consisting of representatives of (but not limited to): the Local Government Association, the Association of Directors of Adult Social Services and the Department of Health.
	(3) The report mentioned in subsection (1) should include a statement of the satisfaction of the Joint Care and Support Reform Programme Board with (but not limited to)—
	(a) adequacy of the funding of the provisions in this Act,
	(b) on-going costs of implementation,
	(c) an additional five yearly review of the short and medium term cost of setting the eligibility criteria at the level set out in regulations.’.
	New clause 11—Provision of certain care and support services to be public function
	‘(1) A person (“P”) who provides regulated social care for an individual under arrangements made with P by a public authority, or paid for by a public authority, is to be taken for the purposes of subsection (3)(b) of section 6 of the Human Rights Act 1998 (acts of public authorities) to be exercising a function of a public nature in doing so.
	(2) This section applies to persons providing services regulated by the Care Quality Commission.
	(3) In this section “social care” has the same meaning as in the Health and Social Care Act 2008.’.
	New clause 13—Deferred payment data
	‘The Health and Social Care Information Centre shall make arrangements to collect and publish data including, but not limited to—
	(a) the number of individuals entering into a deferred payment arrangement,
	(b) the proportion of those individuals who received—
	(i) regulated financial advice,
	(ii) other forms of advice, and
	(iii) no advice
	before entering into a deferred payment arrangement,
	(c) the average length of time a deferred payment arrangement is held,
	(d) the numbers of individuals holding such arrangements broken down by different periods of time held, and
	(e) the amount of money deferred under such arrangement.’.
	New clause 15—National framework for local authority fees for care providers
	‘(1) The Secretary of State shall establish an indicative national formula with which local authorities shall determine the costs of care provision in their area.
	(2) In having regard to the matters mentioned in section 5(2)(b), a local authority must derive fee levels for independent providers of care and support services from the formula mentioned in subsection (1).
	(3) The Secretary of State shall make arrangements for the audit of local authority fee levels to determine their compliance with the duty mentioned in subsection (2) and the extent to which this contributes to the effective delivery of the requirements of section 5(2), with particular reference to paragraphs (b), (d), (e) and (f).
	(4) The formula in subsection (1) shall be made by regulations laid in pursuance of section 123(4) of this Act.’.
	New clause 17—Duty to review economic, financial and other factors affecting provision of care services
	‘(1) The Secretary of State shall make arrangements for—
	(a) a review of the economic and financial factors affecting the employment (including recruitment, training and development, effective deployment and retention) of care workers and the extent to which current policies, mechanisms and relevant compliance by regulated providers of care services make it more or less likely that the objectives of this Act will be realised; and
	(b) a public consultation on the conclusions and recommendations of the review.
	(2) The Secretary of State shall lay a report of the review and public consultation before each House of Parliament by 1 September 2014.’.
	New clause 18—Impact of working conditions on quality of care
	‘(1) In exercising their functions under Part 1 local authorities must assess and consider how working conditions for people employed in care and support services impact on the fulfilment of local authority duties under Part 1 of this Act.
	(2) “Care and support services” means—
	(a) services provided by a local authority; and
	(b) services commissioned by a local authority.
	(3) Regulations may specify particular matters local authorities must have regard to in relation to subsection (1).’.
	New clause 19—Promoting health of carers
	‘(1) In exercising their functions health bodies shall—
	(a) promote and safeguard the health and well-being of carers;
	(b) ensure that effective procedures exist to identify patients who are or are about to become carers;
	(c) ensure that appropriate systems exist to ensure that carers receive appropriate information and advice; and
	(d) ensure that systems are in place to ensure that the relevant general medical services are rendered to their patients who are carers.’.
	New clause 20—Local authorities: duties with respect to young carers
	‘(1) A local authority must ensure that it takes all reasonable steps to ensure that in relation to—
	(a) any school within its area and under its control; and
	(b) any functions it discharges in pursuance of its responsibilities as a children’s services authority, there is in place a policy that both identifies young carers and makes arrangement for the provision of support for pupils who are young carers.
	(2) In discharging its duty under subsection (1), a local authority must have regard to any guidance given from time to time by the Secretary of State.’.
	New clause 21—Further and higher education: duties with respect of student carers
	‘(1) The responsible body of an institution to which this section applies must identify or make arrangements to identify
	student carers and have a policy in place on providing support for student carers.
	(2) This section applies to—
	(a) a university;
	(b) any other institution within the higher education sector; and
	(c) an institution within the further education sector.
	(3) A responsible body is—
	(a) in the case of an institution in subsection (2)(a) or (b), the governing body;
	(b) in the case of a college of further education under the management of a board of management, the board of management; and
	(c) in the case of any other college of further education, any board of governors of the college or any person responsible for the management of the college, whether or not formally constituted as a governing body or board of governors.’.
	New clause 22—Duty for Financial Services Consumer Panel
	‘(1) The Financial Services Consumer Panel at the Financial Conduct Authority shall have a duty to review the availability, quality, adequacy and effectiveness of financial advice being provided to care users and their families on the implications of the relevant provisions of this Act, and make an annual report thereon to the Secretary of State containing recommendations for steps to take to remedy any deficiencies identified by the Panel.
	(2) The Secretary of State shall lay a copy of the report mentioned in subsection (1) before each House of Parliament. The first such report must be so laid within 12 months of this Act receiving Royal Assent.’.
	New clause 23—Financial advice for care users: qualification to provide
	‘(1) The Financial Conduct Authority shall prepare and conduct a review of the implications of the relevant provisions of this Act for—
	(a) training and development; and
	(b) the level of the required qualifications
	for advisers seeking licences to provide financial advice to care users and their families.
	(2) The Authority shall submit a report of the findings of the review mentioned in subsection (1) to the Secretary of State, along with recommendations.
	(3) The Secretary of State shall lay a copy of the report mentioned in subsection (2) before each House of Parliament. The first such report must be so laid within 12 months of this Act receiving Royal Assent.’.
	New clause 24—Public awareness
	‘(1) Local authorities shall have a duty to prepare, publish, consult on and implement a plan for raising and maintaining awareness amongst the residents of their areas of the arrangements for social care, and in particular of any changes to such arrangements brought about by Part 1 of this Act.
	(2) The Secretary of State shall prepare and lay before each House of Parliament an annual report on the level of public awareness and understanding of the arrangements for social care, in particular—
	(a) awareness and understanding of the changes brought about by the provisions of this Act; and
	(b) the effectiveness of local authorities’ implementation of their plans for raising public awareness in their areas.’.
	New clause 26—Declassification of a police station as a place of safety for the purposes of section 136 of the Mental Health Act 1983
	‘(1) The definition of a place of safety in section 135(6) of the Mental Health Act 1983 shall no longer be read to include a police station for the purposes of section 136 of that Act.
	(2) With regard to persons removed to a place of safety under section 136(1) of the Mental Health Act 1983, subsection (1) above shall have effect from—
	(a) 1 April 2015, where such a person is aged 18 years or under; and
	(b) 1 April 2017, where such a person is aged over 18 years.
	(3) By 31 March 2015 the Secretary of State shall prepare and lay before each House of Parliament a report setting out the progress made by that date towards fulfilling the objective set out in subsection (1) above.’.
	New clause 31—Register of persons who provide regulated social care
	‘(1) Health Education England must make arrangements for the compilation, publication and maintenance of a register of persons as set out in section [Provision of certain care and support services to be public functions] who provide regulated social care for an individual under arrangements paid for by a public authority that have undertaken education and training in accordance with the duty set out in section 95.
	(2) This duty may be delegated by HEE to Local Education and Training Boards established under section 101.’.
	New clause 32—Funding and remuneration of home care workers
	‘(1) The Secretary of State shall establish an independent review of the funding and remuneration of home care workers with a view to a report making recommendations regarding—
	(a) hourly salary,
	(b) remuneration of travel time,
	(c) remuneration of travel costs,
	(d) minimum time required properly to fulfil each of the care tasks and duties to be performed,
	(e) establishment of an efficient means of recording arrival and departure times at residential settings, and
	(f) the charging basis of the agency employing the care worker with a view to ensuring that all the costs of providing for (a) to (e) above are adequately met.
	(2) The Secretary of State shall lay a copy of the report of the review mentioned in subsection (1) before each House of Parliament.’.
	Amendment 26,in clause 1, page2,line5, at end insert—
	(j) the right to living independently and being included in the community.’.
	Amendment 21,in clause 5, page6,line2, leave out from ‘must’ to end of line 4, and insert—
	‘(a) have regard to the need to ensure that sufficient services are available for meeting the needs for care and support of adults in its area and the needs for support of carers in its area; and
	(b) ensure that the fee levels provided to independent providers for the delivery of care and support services are derived from a national formula which determines the accurate cost of care in each local authority area, the result of which will mean that the provisions of paragraphs (2)(b), (d), (e) and (f) can be delivered effectively.’.
	Amendment 20,in clause 12, page11,line31, at end insert—
	‘(aa) require the local authority, when carrying out the assessment, to capture an individual’s main and other disabling conditions.’.
	Government amendments 1 and 2.
	Amendment 31,in clause 24, page22,line39, at end insert—
	‘(3A) The Secretary of State shall, after suitable consultation, establish by regulation a specified timeframe for the conclusion of the steps required of local authorities by virtue of this section.’.
	Government amendment 3.
	Amendment 32, in clause 27,page25,line8, leave out ‘keep under review generally’ and insert ‘review regularly’.
	Amendment 33,page25,line42, at end insert—
	‘(5A) The Secretary of State shall, after suitable consultation, establish by regulation appropriate arrangements and timetable for the regular review of care and support plans and of support plans by local authorities provided for in subsection (a).’.
	Government amendments 4 and 5.
	Amendment 27,in clause 42, page38,line24, at end insert—
	‘(2A) There are different types of abuse, as defined in guidance.’.
	Amendment 28,page38,line29, at end add—
	‘(4) A relevant partner, as defined in section 6(7) has a duty, where it has reasonable cause to suspect a person is an adult at risk of abuse or neglect, and the adult appears to be within the local authority’s area, to inform the local authority of that fact.’.
	Government amendments 6 and 14.
	Amendment 22,in clause 76, page69,line33, after ‘adults’, insert ‘and children’.
	Amendment 23,page69,line37, after ‘adults’, insert ‘and children’.
	Amendment 24,page69,line42, after ‘adults’, insert ‘and children’.
	Amendment 25,page69,line44, after ‘adults’, insert ‘or child’.
	Government amendment 7.

Paul Burstow: I hope that the House will forgive my having a number of new clauses to explain in the time available to discuss part 1 of the Bill. I will try to crack on as quickly as possible to explain the thinking behind each of them. I will do so not in numerical order, but in order of importance, starting with the new clauses on which I particularly want to hear the Minister’s response.
	First, I wish to discuss new clause 11, which deals with the Human Rights Act 1998 and its application to social care. The Act has enormous potential to improve the lives of those most vulnerable to human rights abuses in social care settings. People who are being provided care in their own homes or in care homes face risks in respect of their privacy, their family life, being safe and not suffering degrading treatment. Such matters are all very much at the heart of how we ensure that we provide dignified care.
	I am sure that the Minister knows, as do other hon. Members, that a loophole has opened up in our law as a consequence of a judgment made by the courts some years ago. It arose in 2007 following the decision by the House of Lords in the YL v. Birmingham city council case. The Law Lords held that a private care home providing residential care services under contract to a local authority was not performing a “public function”, so its residents were excluded from the protections of the Human Rights Act. In practice, that means that domiciliary care users, or their families or carers, can complain to the care company, depending on the terms of their contract, but in many cases they will not be able to take their complaint any further. Contractual terms and conditions are important, but they can often fail to give the protection that we would want to see, and residents in care homes have no security of tenure and are often afraid to complain because of fear of eviction.
	Many people with care needs face additional challenges asserting their contractual rights, particularly if they lack the capacity to do so because of dementia or learning disabilities.
	The decision that private and third sector care home providers were not directly bound by the Human Rights Act meant that thousands of service users had no direct legal remedy to hold their providers to account for abuse, neglect and undignified treatment, even though the public body commissioning those services remains bound in law by the Human Rights Act. There is need for change in this area. The loophole was partly closed by the previous Government, with cross-party support, through section 145 of the Health and Social Care Act 2008, which covers residential care services. However, under changes that this Bill will introduce, it will need to be reinstated by order, but there is a far better and more elegant way in which that could be done—by implementing new clause 11.
	New clause 11 seeks to clarify the law so that all providers of publicly arranged or paid-for care are within the scope of the Human Rights Act. Service users who experience serious human rights abuses will then have direct means of legal redress. However, this is not just about going to law; it is about what goes on in the hearts and minds of those organisations and the attitude they take towards how they provide services, so the Human Rights Act has a part to play in culture change as well. For example, the Act has been successfully invoked in an argument about a local authority’s refusal to place a married couple in the same nursing home.
	The Government have accepted that there is a loophole, and we very much welcome that. We raised the matter during consultation on and scrutiny of the draft Bill, and we offered up a suggestion, which their lordships adopted. In response to the Joint Committee, the Minister told us that organisations that were not covered by the Act should none the less consider themselves bound by it. Lord Hope, the recently retired Deputy President of the Supreme Court had this to say about that:
	“Comments of the kind that were made, that people should consider themselves bound by a convention right, however well intentioned, do not have the force of the law”.—[Official Report, House of Lords, 16 October 2013; Vol. 748, c. 549.]
	That is why we need to give it the force of law, which is what new clause 11 attempts to do. It puts back the law to where Members of all parties expect it to be, and ensures that a poor judgment by the court is corrected.
	New clause 1 deals with the issue of power of access. Last week, I handed in a letter to the Prime Minister, setting out the case for the measure. It was signed by 602 organisations and individuals, including Age UK, Mencap, the National Autistic Society and many others with expertise in the area of adult safeguarding. They all share a common concern that there is a gap in the law when it comes to protecting vulnerable people who have the ability to make decisions for themselves but who are living in a home with someone else who is abusing them or neglecting them and who is denying them, because of their ability to exert their authority over that person, the ability to get the protection that they need. The Law Commission took that view in its review of mental capacity legislation, and the Equality and Human Rights Commission also took that view in its analysis of the legislation.
	In our debates in Committee, my hon. Friend the Minister of State said that when officials were asked to provide the evidence behind their advice that the new power was unnecessary, there was an opaqueness surrounding the issue. There was not the necessary level of clarity to understand what powers could be used and in what scenario. I must say to the Minister that the scenarios that have been offered up to justify the position that there is no need for legislation do not address the circumstance that I and my new clause 1 seek to address. I am talking about someone who legally has capacity but who is under duress and unable therefore to exercise their individual right to seek protection. As a consequence of that, we need this power.

Meg Munn: I added my name to the right hon. Gentleman’s new clause. Does he agree that the Bill is putting in place a range of measures on new safeguarding boards, and that this power would complement the work that is now being done to raise the whole issue and to ensure that vulnerable people get the protection they need and their circumstances properly investigated?

Paul Burstow: The hon. Lady is right, and with her own experience in social work practice, she will know why this matters so much. She is right to say that in the Bill, for the first time, many aspects of adult safeguarding are put on a statutory basis, which is welcome. None the less, there is still a gap, which the Government with this Bill should seek to fill. We have had a lot of back and forth between the Minister of State and his officials, and I am grateful to him for the patience that he has shown. I just hope that the patience translates into something else. However, he has told Members that there is a balance of risks, and his judgment is that the powers are not needed. I say to him and to officials that if that is the case, why, in the scenario that I have described, can he not produce the evidence?
	I welcome the fact that the Social Care Institute for Excellence has been commissioned to do work on this issue, but if there is a gap in the law, that will not fix it. It has been suggested that the problem is that practitioners are ignorant of the law. Again, I have to ask where the evidence is for that. Thanks to Action on Elder Abuse, which instituted a freedom of information request, we know that the evidence does not support that line either. So far, 84 out of 152 local authorities have responded. Twenty-nine councils have reported at least one instance in the past 12 months in which they have been unable to gain entry because a third party had denied them access. In 21 of those cases, they never gained access. Therefore, all the arts of negotiation and relationship building that are essential to good social work practice did not gain those people access, and who knows what happened to those individuals. Let us hope that they do not find their way on to the front page as a tragic story.
	Not a single one of the 84 authorities that responded to that request have suggested that a failure to gain access was the result of a lack of knowledge. It is really about a lack not of knowledge but of that backstop power, which the new clause provides. In a survey of front-line practitioners, 365 of whom have responded, 82% believe that the power is necessary.
	New clause 1 provides a proportionate power for a circuit judge, approved by the Court of Protection, to determine whether an entry warrant should be granted
	where a person is believed to be under duress and a victim of abuse. Let me be clear that the measure should be rarely used, but it is required for those circumstances in which a person is in the situation that I have described. I agree with the Minister about good social work, but just talking about good social work is not an adequate answer.

John Redwood: Who drafted new clause 1 and which main outside organisations support it?

Paul Burstow: Organisations that have supported the new clause, which I have drafted, include people with a legal background, social workers, Age UK and Mencap—those who often provide a voice for the voiceless. One of my concerns is that the people whom the Bill seeks to benefit are very likely to be those who are under duress and therefore unlikely or unable to express an opinion. That is why the new clause has been crafted to try to ensure that the necessary safeguards are built in.
	New clause 3 addresses the issue of carers, particularly the identification of carers. Carers are the backbone of our care and support systems. Without them, those systems could not function in delivering the quality of care that we would expect. Those carers make huge sacrifices to care for their loved ones. Their health, their wealth and their lives are often sacrificed as a result of what they do. We know from the census that a carer is twice as likely to be in bad health as a non-carer.
	The Government should be applauded for the fact that in this Bill and in the Children and Families Bill they have taken great strides to improve the rights of adult carers, parent carers, and young carers. They have listened, engaged and responded to the concerns that Members in all parts of this House and in the other place, and many carers’ organisations, have raised with them. However, all this hinges on whether carers are aware of these new rights and whether their council is successful in its new duty of identifying them, as required under the Bill. The problem is that the NHS is still left untouched. Millions of people caring for someone with a health problem may never come into contact with their council or be aware that that would be the next step in coping with their situation.

Barbara Keeley: I welcome the right hon. Gentleman’s conversion to the identification of carers by NHS bodies, because when he was in the role of Minister he did not support that. I hope that he can convert the current Minister. Is it not the case that, as Macmillan Cancer Support has said, 95% of carers for people with cancer, who may care for only a short time but for people with terminal illness, do not have any contact with local government and do not have a carers’ assessment, and is not that the key? Are we just going to let those people struggling in those difficult circumstances carry on doing so?

Paul Burstow: The hon. Lady is not a convert. She has been consistent and clear in her pursuit of this provision, both with her own Government and with this Government, and I hope that eventually her persistence will pay off. It has persuaded me, along with many carers’ organisations, of the need for such a change.
	Institutionally, the NHS is not good at grasping the different responsibilities it has towards carers compared with those who are its immediate concern—the patients.
	As a result, it lets carers down institutionally, and that is what the new clause says we need to address. We need to change the NHS’s mindset institutionally to make sure that it recognises its responsibility for millions of people with caring responsibilities and asks the necessary questions. Macmillan Cancer Support has found that 78% of health care professionals have come across a cancer patient who has been admitted because their carer could not cope at home. Here is why the NHS must fully engage with carers: only one in three professionals who sees an accompanied patient always goes on to check whether the person with them is their carer.

Sarah Newton: I, too, have supported my right hon. Friend’s new clause, because this is an essential point. This Government should be proud of the support that they have introduced for the legion of unpaid carers who do such a fantastic job, but if their doctors, district nurses and health care professionals do not let them know about these rights, they are not really worth having.

Paul Burstow: That is absolutely right. This is not, as it can sometimes be portrayed, a case of “Let’s just have a tick-box”; it is about signalling a set of changes that need to happen in the culture of the organisation, so that when a patient visiting their GP or a consultant is accompanied by a member of their family or someone else who is supporting them, that instinctively forms part of the conversation about signposting and information about carers.
	At the moment, just 7% of practitioners always signpost for a carers assessment. That is why we need to make sure, through this new clause, that we place a simple duty on the NHS so that it plays its part in identifying carers. One of the most shocking statistics is that 64% of health professionals think that that is necessary. They think that it will help them in their day-to-day practice and in ensuring that the issue is put up the agenda.
	In Committee, the Minister talked about the work that NHS England is doing and its commitment to carers and the action plan that is being developed through consultation with carers and carers organisations. That is incredibly welcome and a good step in the right direction, but what are needed are effective procedures and systems to identify carers right across the NHS. The Government must make that a priority and the Bill provides an opportunity to do so; otherwise, only those places that get it will continue to do it, while those places that do not will not, and we will not see the progress we need.
	The Minister also said in Committee that he would give consideration to statutory guidance. If there is to be such guidance, it has to have very clear requirements on the NHS. As I have said, it should be not a tick-box exercise, but a kick-start for the culture change to make sure that carers are properly valued and respected and given access to the support intended by the Bill.
	New clause 4 is about charging. The change proposed is small, but its potential impact is huge. The Bill provides for regulations to be used to govern the way in which charges are set for local authorities with regard to providing or arranging care and support. In Committee, I raised a concern that I first raised in the Joint Committee’s
	scrutiny of the draft Bill—that the removal of section 17(3) of the Health and Social Services and Social Security Adjudications Act 1983, which requires that charges should not be more than is “reasonably practicable”, is an important issue of principle and of protection and safeguarding in the system. The Minister undertook to give the issue careful consideration and in a letter to members of the Committee on 12 February he offered some reassurance. He wrote that, under the Bill, a local authority would have to consider what a person
	“would be likely to be able to pay towards the cost”.
	Regulations would then go on to prescribe the formula for calculating the minimum amount of income with which a person should be left.
	My hon. Friend also pointed to the duty on both the local authority and the Secretary of State to have regard to the duty for well-being, which is the first guiding principle of the Bill. Will he confirm, therefore, that, in coming to a view about the reasonableness or otherwise of a charge, a court would examine it against whether someone was
	“likely to be able to pay”
	and the duty under clause 1? It would be very helpful for future interpretation if he clarified that.
	New clause 13 deals with another issue that was raised in Committee, but it takes a slightly different tack. Many, particularly the Local Government Association, have suggested that we should have a national scheme to operate deferred payments. However, they have also said—many think this is necessary—that at this stage, given that deferred payments can be equated with other financial instruments that are regulated in a more strict way than that intended for deferred payments, the Government should at the very least provide assurances that they will carefully monitor what will happen with the increased numbers of direct payments, not least because of the concern that we may wind up with people being mis-sold the products with less redress than they might have with regard to other financial products.
	New clause 15 relates to fair fees and to new clause 9, which I will come on to in a moment. It was striking that in Committee we returned on a number of occasions to issues relating to procurement decisions by local authorities. I proposed a mechanism for adjudicating disputes between councils and providers about the fees on offer to the providers. However, it is not adjudication that we really need, because that is the wrong end of the pipe—it is what happens when things have broken down, relationships have not worked and fees have been set at an unsustainable level. What is needed is transparency and certainty in the way the fees are set.
	The Bill provides for people paying for their own care to ask the council to arrange their care in return for a fee. The concern is that, without transparency on the rate setting, councils will drive the price for care to unsustainable levels. Indeed, that is already happening in some care markets around the country. Only providers that sacrifice quality, reduce staffing and generally cut corners would still be able to stay in the market. For those who rely on such services, the consequences would be higher staff turnover, limited choice and poorer quality.
	In that regard, both Care England, which represents residential care providers, and the United Kingdom Homecare Association have grave concerns about the
	unintended consequences of some of the measures. When I met UKHCA members in February, they were very clear that below-cost pricing by local authorities was a growing problem. According to Laing and Buisson, English councils are paying £480 on average for residential care, although the assessment of a fair market price was about £651. The issue concerns the use and abuse of monopsony power in a financially challenged market. It also relates to new clauses 7 and 9, which I will come on to in a moment.

Mike Thornton: My right hon. Friend mentions Laing and Buisson. I believe that it has come up with a formula that should enable people to work out a fair funding system in advance. Is that something we could look at?

Paul Burstow: My hon. Friend is absolutely right. That is the basis of the average fair rate, which I mentioned. New clause 15 would provide a mechanism for establishing a formula by which fee rates are set transparently for both domiciliary and residential care. The organisations representing the sector believe that that would lead to much greater transparency, and I think that it would deal with some of the rather toxic relationships that sometimes appear to exist, both nationally and locally.
	New clause 2 is about older people, particularly the proposition that we should take a leaf out of the book of our colleagues in Wales and Northern Ireland in relation to having a commissioner for older people. Ageism and ageist attitudes are endemic in our society and, indeed, in public services. Our society is ageing, with life spans increasing, and that profound change will affect us all. It has implications for how the NHS and care services behave, but it goes far wider.
	My new clause simply calls on the Government to work on the mechanics of establishing such a post so that there is someone to listen to and give a voice to older people; to champion their vital contribution to our economy—in work, as care givers and as volunteers, mentors and community leaders—rather than their being seen as burdens, which is how older people are all too often portrayed; to challenge the complacent and lazy stereotypes; and to hold public services to account.
	Such a role already exists in Northern Ireland, Wales and other parts of the world. It would involve asking such questions as: why do the 360,000 cases of abuse suffered by older people every year lead to so few prosecutions, why are older people excluded from clinical trials and other research, and why do we stop reporting people’s cancer survival rates once they pass the age of 75? I hope that the Minister is open to the idea, and I look forward to his response.
	New clause 26 deals with the issue of mental health, which came up very briefly in Committee. I know that the Minister is a passionate champion of mental health concerns. The new clause simply says that if a person has an accident—for example, breaks their arm—suffers a stroke or has a heart attack, the last place they would expect it to be sorted out is a cell in a police station, but that that is exactly where people who have a mental health crisis find themselves. The statistics are stunning: 36% of all people who are taken to a place of safety find themselves in a police station and stay there for more than 10 hours. Not only have adults been subject to that
	process, but 263 children, on the most recent figures. My new clause simply seeks to place a sunset provision on the definition of a place of safety, including a police station, which should create a way of concentrating minds to ensure that services are provided in the right place at the right time for children and adults.
	I come to new clauses 7 and 9 last because they are about addressing what we might regard as the elephant in the room in any conversation about care services and the Bill’s noble intentions of improving the quality of care and of driving well-being into the heart of how care and support are delivered. The new clauses raise interconnected questions about the future funding of care and support, and about the independent nature of our health and care systems. Social care has for far too long—for decades—been the poor relation to health in decisions about public expenditure. Today’s funding challenges are chronic and are not simply the result of deficit reduction.
	New clause 9 reflects the concern of a remarkable coalition of interests outside this place, including the Local Government Association, the Care and Support Alliance, hundreds of non-governmental organisations, directors of social services and chief executives, and many more besides. They all want to serve notice on the Government that they are concerned about the serious impact that the continuing pressure on local government spending will have on the ability of councils to deliver the care and support that everybody in this House wants to be delivered under the Bill. The picture is complex. Different councils are coping differently—some are overspending their care budgets and some are underspending them—but the trend is clear, despite the extra £7.2 billion that was allocated in the 2010 spending review and the transfer of money as part of the better care fund in the most recent spending review.
	New clause 9 simply provides for an assessment to be made and signed off by the programme board that oversees the implementation of the Bill. It is not an unreasonable request that we check that the sums add up and that the money is sufficient to deliver what the Bill is about. I hope that the Minister will reassure us about how transparent that process will be. Impact assessments are one thing; this process would be another. I think that it would provide considerable reassurance to those who will have the job of implementing the legislation.

Grahame Morris: I apologise for breaking the right hon. Gentleman’s flow. I agree with virtually everything that he has said. On the need to ensure that the Bill does everything that it says on the tin, may I draw attention to the fact that when I met my constituent, Jason Roche, who is very active in the Royal National Institute of Blind People, he pointed out that 43% of blind and partially sighted people in England have lost access to adult social care services since 2005. Does the right hon. Gentleman agree that the Bill must address the needs of working-age adults who suffer from disabilities?

Paul Burstow: I am grateful to the hon. Gentleman for that intervention. He makes an important point. If one looks at the trends, one sees that there is no doubt that there are questions to be asked about why some people are not receiving the service that one would
	expect. Some of that—although I do not pretend that this covers anywhere near all of it—can be explained by the changes to the way in which services are organised. Some of it can be explained by the need to do more to re-able people and to enable them to maintain their independence. I do not say that to evade the question. That is why I have put new clauses 7 and 9 before the House. I genuinely think that whoever is in government in future will have to have a much more systematic approach to making decisions about how we meet demand.
	That brings me on to new clause 7, which simply says that the Government should take a longer-term view. It states that every five years, the Government should look 20 years forward and take an independent assessment of the future demand for care and health services. That could be done by the Office for Budget Responsibility. It could provide modelling for the whole health and social care system that looks at the impact on demand, technology, demography and health status, and at the balance between all those factors. It could also look at the interactions between health and care, primary and secondary care, physical and mental health, and treatment and prevention. That would finally implement a recommendation that was made by Derek Wanless in his review for the Government in 2000. That is supported by the King’s Fund, which has suggested much the same thing.
	In Committee, neither the Government nor the Opposition were able to make any funding commitments about part 1 of the Bill. I entirely understand why that is the case. However, we know that as the eligibility criteria are drawn more tightly, more people are excluded from help. In the long run, that does not save money, but shunts the costs. It pushes people away from living an independent life and towards a life of dependency. I hope that all parties will, in the end, sign up to something like new clause 7 as a good part of the future sound governance of our health and social care system. I hope that the Minister will support that.
	I apologise to the House for speaking at such length, but I have put forward a number of issues that I hope will provide a framework for debating this important set of reforms. I look forward to the Minister’s response.

Liz Kendall: We are discussing a huge number of new clauses and amendments, and I will try to keep my comments brief to allow Back Benchers on both sides time to speak. I want to start with our new clauses 17 and 18, which deal with the critical issue of linking the quality of care with standards in the care work force. New clause 17 would require the Secretary of State to review the economic and financial factors affecting the employment of care sector workers, including their recruitment, training, employment and retention, and the extent to which the policies of care providers were making it more or less likely that the aims of the Bill were being achieved.
	New clause 18 would ensure that local authorities assessed and considered how the working conditions of people employed in care and support were affecting the ability of councils to fulfil their duties under part 1 of the Bill. This would apply to staff who were directly employed by the councils as well as those working for private and voluntary organisations that councils had
	contracted out to. The two new clauses state that if we want to improve the quality of care, we need to take a serious look at what is happening in the care work force, and to assess how people’s pay, terms and conditions and training are impacting on the better provision of care and support that we all want to see.
	We know that an increasing number of frail, elderly people are getting home visits that last barely 15 minutes. That does not give the carer enough time to make a cup of tea, never mind get a frail, elderly person up, washed, dressed and fed, particularly if that person has dementia. Anyone who knows someone with dementia will know that mornings are a particularly difficult time for people with that condition. Care staff are being forced to rush from one person to another because of the way the care is commissioned and because of the squeeze on council budgets. According to the United Kingdom Homecare Association, one in 10 visits is now only 15 minutes long, and Leonard Cheshire has found that the proportion of visits lasting that long has risen by 17% over the past five years.
	Care workers often do not get the proper training that they need. Camilla Cavendish’s review found that for many staff no minimum educational training requirements had to be met before they started working in social care. She heard from some home care workers whose induction had consisted simply of their being given a DVD to watch before they were sent out to work.
	It is estimated that about 300,000 care workers are on zero-hours contracts. Some people might genuinely want to be employed on that basis, but thousands do not, because it makes it virtually impossible for them to budget for themselves and their families, to secure a home—some cannot even afford to rent a home, never mind get on the housing ladder—or to plan their lives. Those arrangements are also not good for the people using the care services: they need to know who is coming to look after them. Imagine having someone different coming in each morning to get you out of bed, take you to the toilet and wash you. You would want to know who was coming in; you would want continuity of care.

Jonathan Edwards: The Social Services and Well-being (Wales) Bill is going through the Welsh Parliament. My party tabled an amendment to the Bill that would have prohibited the use of zero-hours contracts in the care sector in Wales, but the Labour Government there voted against it. How disappointed is the hon. Lady with her colleagues in Wales?

Liz Kendall: I am sure that my colleagues in the Welsh Assembly want to do everything they can to improve care and support. Today we are discussing the care sector in England, and I hope that the hon. Gentleman will give his support to what we are proposing.

David Davies: Will the hon. Lady give way?

Liz Kendall: I am really sorry, but I want to make a bit more progress. I have a lot of new clauses to get through, and Back Benchers have also tabled new clauses and amendments.
	We also know that many care workers do not even get the minimum wage at the end of the week, because they are not paid for their travel time, among other things. Her Majesty’s Revenue and Customs recently undertook an evaluation of minimum wage enforcement in the social care sector. It found that a staggering half of all care providers had failed to pay the minimum wage to at least one of their employees, yet despite Ministers’ insistence that such people will be named and shamed, not a single provider in the care sector has so far been identified.
	We need to look at all those employment issues, which I think have a fundamental impact on the quality of care. If the Bill is to promote well-being, shift services towards prevention and improve standards, we must get to grips with those issues; otherwise, it will not work. New clause 17 would require the Secretary of State to conduct an overall review of the economic and financial factors affecting employment, publish the results and consult on the findings.

John Redwood: I quite agree that we need a high quality work force who are well trained and supported, but if the review concludes that they are not, is the hon. Lady saying that controls should be imposed on local authorities from the national level?

Liz Kendall: If the right hon. Gentleman reads our new clause 18, he will see what our approach is. Local councils commissioning social care and having to fulfil their obligations under the Bill will need to look at employment terms and conditions. We have tabled the new clause because unfortunately the Government are removing the Care Quality Commission’s role in assessing how well councils are commissioning services, which I think is a mistake.

Alison McGovern: Given the point my hon. Friend has just made, does she agree that it is all the more important that councils up and down the country follow the lead that Labour Wirral has shown in sticking to the principles of Unison’s ethical care charter, which tries to rid us of 15-minute appointments and limit zero-hours contracts?

Liz Kendall: I know about the approach that has been taken in Wirral and think that it is an excellent example. If we kept the CQC’s role in assessing how well councils are commissioning services, that is just the sort of thing that it would be able to spread. It is a real problem that that role is being removed. We will come later to our amendments that seek to return it to the CQC.
	I will now turn to a group of new clauses on how better to identify and support carers. They stand in the name of Opposition Front Benchers, but really they are the work of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has made sterling efforts in this regard. We have tabled them to give carers the focus and attention they deserve. They pick up on some of the points that the right hon. Member for Sutton and Cheam (Paul Burstow) made. New clause 19 would ensure that all health bodies have effective procedures in place to identify people who are or are about to become carers and ensure that they get the help and advice they need. New clause 20 would require local authorities to take all reasonable steps to
	ensure that schools in their area identify young carers and put support in place. New clause 21 would require universities and colleges to do the same.
	As the right hon. Member for Sutton and Cheam said, family carers—unpaid family members looking after the people they love—are the absolute backbone of our care system. They need and deserve more support. They are looking after their relatives because they want to, but they really need help. One in five family carers provide more than 50 hours of care every single week, and their own health suffers as a result. One in three have to give up work or reduce their hours, which means their income suffers and the cost to the taxpayer goes up.
	The Bill puts in place welcome new rights for carers, building on the approach taken by the previous Labour Government, but they will be meaningless if carers are not identified in the first place. Many carers do not actually come into contact with local authorities. Macmillan Cancer Support has made a powerful case, showing that 95% of the over 900,000 carers of people with cancer in England have not received a carer’s assessment—only one in three of them have even heard of it. That is because they are mostly in touch with the health system. Unfortunately, hospitals and GPs still do far too little to identify carers of people who have cancer and other conditions, such as stroke and heart disease. I understand that GPs identify only around 7% of carers, and other health professionals, particularly in hospitals, identify only one in 10. We need clear duties on those bodies and proper processes in place, because too often at the moment there is just a tick-box approach. I recently had to move GP practice, and the form I filled out contained two pages on how much alcohol I drank, which was welcome, and a little box that asked, “Are you a carer?” I knew what that meant—but did it mean a paid care worker, or a health care worker? That is not good enough and needs to be thought through.
	I also stress the need to do far more to identify young carers, who we know can see their lives and life chances suffer because of what they do to help look after sick or disabled parents. Many schools might not understand if kids are not doing their homework or not turning up on time because of their responsibilities. If young carers are lucky enough to get to university or college, they may find their studies hard because they are travelling to and from home to try to help support their loved ones. We believe there should be clear duties on those bodies to identify young carers.
	New clauses 22, 23 and 24 are about getting people the right financial advice—an issue we discussed a lot in Committee. The Bill introduces a new and complicated system of social care funding with the so-called cap on care costs and new deferred payment schemes. It is complicated and I have lost track of the number of times people have said to me, “Well, it’s okay because at least my care costs will be capped at £72,000 now”, and I have to go through the process of explaining to them that that is not actually the case. People are unaware of the new system, and if they are looking at financial products to help them cope with later costs, they need decent financial advice.
	Currently, financial advisers must have studied a range of different financial and regulatory subjects, and they must sign up to a statement of professional standing and a code of ethics and conduct. Has the Minister
	talked to the Financial Conduct Authority about whether the training of financial advisers should change as a result of the Bill? Is he confident that all financial advisers can give people advice about the products they might want to take out to protect themselves against future costs, on the basis of the Bill?
	I am concerned that unless people get high quality, proper financial advice, we could be in for another mis-selling scandal because the issue is complicated. People will have to figure out how much their average local authority rate will be for their area in five, six or seven years’ time, and how different that will be from what private providers charge. Will people’s care needs enable them to start counting towards the cap on care costs if they are not defined as “substantial”, as under current eligibility criteria? I would struggle to figure out all those finances, and we must ensure that financial advisers are properly trained.
	New clause 22 states:
	“The Financial Services Consumer Panel at the Financial Conduct Authority”
	should publish an annual report on the
	“availability, quality…and effectiveness of financial advice”
	available to care users and their families. New clause 23 states that the FCA should consider raising the level of qualifications that financial advisers must have. We must ensure that people get high quality financial advice so that they are not mis-sold any products.
	We also want much greater efforts to raise public awareness of the new capped cost model introduced by the Bill. Under the Bill, local authorities have a duty to raise awareness, but new clause 24 would make that much stronger and require them
	“to prepare, publish, consult on and implement”
	a proper plan for raising awareness among their local residents. That is important so that people know about the new system and what it means for them.
	I support new clause 11, which would ensure that all users of publicly funded or arranged care have direct protection under the Human Rights Act 1998. Under the law as it stands, the fundamental protection and access to individual redress offered by the Act are not applied equally in all care settings. In the other place, Lord Low tabled the former clause 48, which sought to close that loophole. There was a long discussion on it in Committee—the clause was passed in the House of Lords but the Government voted to remove it in Committee. The Minister’s argument was that it went too far, because it would mean that the Human Rights Act applied to entirely privately funded and arranged care. He also claimed that the clause was not needed because the CQC could deal with the problems.
	Since that Committee, the Joint Committee on Human Rights has published its analysis of the measure. It states:
	“The Bill provides an opportunity to fill the gaps in human rights protection for all those receiving publicly arranged care…and we recommend that the opportunity to legislate to this effect not be missed”.
	The Joint Committee proposed new clause 11, to which the right hon. Member for Sutton and Cheam and I have put our names. It differs from the former clause 48
	by making it clear that its scope is confined to regulated care services that are either publicly arranged or publicly funded.
	The Joint Committee on Human Rights says that the law must be clarified. Organisations including Age UK, Mind, the Alzheimer’s Society, Mencap, the Law Society and the Equality and Human Rights Commission agree. New clause 11 deals with the concerns that Ministers and others have raised. It is an important point. Why should people who have their care arranged by the local authority but pay for it themselves not have the same rights? Someone who has entirely publicly funded and arranged care can get redress under the Human Rights Act. We need to fill that gap.
	I support new clause 9, which is an important one. It would require the Department of Health’s joint care and support reform programme board to produce an assessment of the adequacy of funding for the provisions of the Bill and the ongoing costs of implementation. It would also require the programme board to conduct a five-yearly review of the short and medium-term costs of setting the eligibility criteria at the level set out in the regulations, which, according to the Government, will be substantial.
	Local councils will be required to take on substantial new work as a result of the Bill. That includes assessing thousands of additional users and carers, who currently do not get an assessment because they fund their own care; setting up new care accounts to keep track of how much money people have spent, in order to figure out when they reach the so-called cap on care costs; establishing and running the deferred payment schemes; running information campaigns about the new system; and training staff in the new capped-cost model of funding.
	The Local Government Association and the Association of Directors of Adult Social Services have strongly argued that there needs to be a thorough assessment—it is only an assessment—of the costs of delivering the new roles, so that the Bill can be properly implemented. Why is that so important? Many councils thought they would get additional resources to support the Bill’s provisions. In the spending review, the Government said that the money would be new funds for the Bill. However, when the details of the local government funding formula were revealed in July, it transpired that the money was not new money for the Bill—the Government were simply top-slicing existing council budgets. That means that councils will have to take money from existing care users, many of whom are desperately struggling with low levels of, and poor quality, care and support, to set up the extremely complicated new system of care accounts, the capped-cost model and deferred payments. We need openness and transparency about what the measure will cost and where the money will come from if we are to assess whether the priorities are correct.
	The five-yearly review of the short and medium-term costs of the eligibility criteria for social care is extremely important. Hon. Members will know that many organisations that work with older and disabled people and their family carers welcome the framework set out in the Bill to promote well-being, to prevent the need for care and support, and to integrate local care and health services, but those organisations are very concerned that these objectives will not be achieved if the eligibility criteria are set too high, which will mean that people lose out on care and support. This is not good for them
	and does not make sense for taxpayers. If older people do not get the grab rail that helps to prevent them from falling, or decent care and support at home that helps them get up, washed, dressed and fed, and they end up having to go into hospital or more expensive residential care, it is not good for them and it costs us all more.
	For working-age disabled people—

David Ward: Will the hon. Lady give way?

Liz Kendall: Perhaps the hon. Gentleman will let me finish this point.
	For working-age disabled people, the level at which the eligibility criteria are set is crucial and could mean the difference between being able not just to get access to training and a job but to spend time with their family or go out into their community—things that we take for granted. As hon. Members know, Scope and other organisations have warned that the Bill could risk shutting more than 100,000 disabled people out of the system, with all the human and economic costs that that entails.
	The Minister will know that in Committee many hon. Members cited the economic modelling that has been done by organisations such as Deloitte, which shows that shifting the focus of investment and resources up front can save more money further down the line. The Deloitte modelling predicts that for every £1 invested in care for disabled people with moderate needs, savings of £1.30 per person are created. It predicts £700 million of savings for central Government from helping disabled people and their family carers to get work, and £570 million of savings to local NHS and local council services by avoiding the use of more expensive residential and crisis care and by reducing the need for more expensive medical care.
	Such a long-term approach, whereby we assess the true costs and benefits over a longer term, is a good framework for making decisions about where priorities lie—

David Ward: Will the hon. Lady give way?

Eleanor Laing: Order. Before the shadow Minister considers taking further interventions, she may not have realised that although the House appreciates that she is making some important points on a complex matter, she has spoken for some 24 minutes. She will not be aware, but I am, that a very large number of colleagues wish to speak in this debate and there is a limited time, so she might consider bringing her remarks to a close.

Liz Kendall: Thank you, Madam Deputy Speaker. I have two more paragraphs. I agreed that I would speak for 25 minutes, so at 24 minutes I am almost in.
	New clause 9 would help secure that shift in approach. I ask hon. Members to consider the new clause seriously because we need to introduce the up-front prevention, help and support, which requires a change in the way we look at the costs and benefits in the system.

Several hon. Members: rose—

Eleanor Laing: Order. Before I call anyone from the Back Benches, let me say that the shadow Minister has been most courteous in bringing her remarks
	to a conclusion when I indicated that that might be a good idea. It would also be a good idea, if Members wish to be courteous to their colleagues, if they would limit their remarks to some five minutes. That way everyone will get to speak. If anybody speaks for more than 10 minutes, I will remind them of the fact.

Tony Baldry: I am not quite sure who to be bad-tempered with. As the House knows, I am not characteristically bad-tempered, but I think my bad temper should probably be directed at the usual channels, given that the timetable motion went through on the nod. We have to deal with 21 new clauses and 20 amendments on an important Bill in two hours, which by my calculation allows three minutes per clause or amendment. The hon. Member for Leicester West (Liz Kendall) spoke perfectly reasonably, given the number of amendments that have been tabled, but it is impossible to do justice to all this in two hours. The usual channels should bear in mind that some of us feel rather bad-tempered about the time provision. These things, as we all know, are agreed between the usual channels; it is not one side or the other that is responsible.
	I wish to speak briefly about new clause 3. The Bill does fantastic things for carers, and I think it would be a real tragedy if, once the Bill completes its passage, carers or their advocates felt that it was a missed opportunity. I shall not repeat what my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) said. The Minister will doubtless say that clause 6 and the duty to co-operate deal with this point. Clearly, the duty to co-operate is very important for local authorities and the NHS. In the past, GPs may not have sought to identify carers as well as they could because they did not think there was much they could do for them. Now they will be able to ensure that there is a carer’s assessment. If the Minister intends to resist new clause 3, could he seek to ensure that we have statutory guidance for the NHS on the services that it should provide for carers?
	I fully understand that for those aged over 75 the aim will be to have named clinicians, and those clinicians should, as part of their duty, ensure that carers are identified, but of course many carers, including young carers, are under the age of 75. It would be a real pity if the Bill missed this opportunity on carers. If we could have some statutory guidance on what the Minister, the Department and all of us expect the NHS to do to identify carers, we can then have a quick rendition of the “Hallelujah Chorus” and I will not be so grumpy.

Hazel Blears: I shall do my best not to be grumpy and to be as quick as the right hon. Member for Banbury (Sir Tony Baldry). I wish to speak in support of new clauses 9 and 19. New clause 9 has support across the breadth of organisations from the Association of Directors of Adult Social Services to the Care and Support Alliance. It makes fundamental good sense, when setting up a new system, to have the ability to have an annual report about whether there is sufficient money in the system. Whichever Government are in charge, we need to know that. We are in danger of willing the ends but not the means for social care, and we have to make sure that this issue is kept under close review.
	We all support the two fundamental principles of the Bill, which are about promoting individual well-being and moving towards a more preventive system. Those
	are commendable and high ideals, but if we do not have the funding in the system to be able to deliver them, the Bill will not achieve the potential that we all know is there.
	I spoke on Second Reading about transformation, and I look forward to welcoming the Minister to Salford on Wednesday to show him how we are transforming the system for dementia care in the city by bringing together £97 million of our total health and social care budgets to try to squeeze every bit of impact out of every last penny to give better care for people with dementia. I hope he will be impressed, but more than that I hope he will help us to do this with his better care fund. That fund should be used for the transformation of our services at a time of austerity when we need more money in the system.
	The second part of the new clause is about having a five-yearly review of eligibility criteria, which is essential—to be frank, I would like to see that happen more often than every five years. Eligibility criteria are now set at “substantial” instead of “moderate”, which means that in Salford 1,000 fewer families are being helped, and the heartache and misery that that causes are enormous. It also goes against the second fundamental principle of the Bill. If we do not have eligibility criteria at the right level, how can we transform the system to be preventive? If we only pick up people when they are in crisis, they are escalated into the acute sector, which costs a fortune. If we invest in lower level community-based interventions by social enterprises and voluntary groups, we can save money in the acute sector.

Meg Munn: Does my right hon. Friend agree that even when people’s needs are substantial, they are often not getting the support they need because the local authorities are not recognising that low level services, such as shopping and cleaning, help to support the care that is being provided by families? The Government need to have clear guidance on this.

Hazel Blears: My hon. Friend, as ever, makes an extremely worthwhile and practical point. Simply having the words in statute does not always portray the real position on the ground. A small intervention can often help to stop things becoming a crisis.
	In Salford we are having to make cuts of £600,000 from transport for disabled people. For many, this could lead to family breakdown. We are in consultation to see whether we can alleviate the worst of the impact, but some of the most disabled people one can imagine, who have complex needs, face the possibility of not having transport.
	I support new clause 19(1)(d), which would
	“ensure that systems are in place to ensure that the relevant general medical services are rendered to their patients who are carers.’.”
	I commend my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) for her commitment on this issue, and I want to give one brief, personal example. Last year, my father, who is 84 years old and a full-time carer for my mother who has dementia, had a medical problem. It took us some time to get him the simplest of medical attention, and in that time my mother had to be admitted to respite care. She was there for four weeks, during which time her condition declined
	dramatically. It would have made much more sense, as well as being in the economic interests of the health service, for my father to have received fast-track medical treatment.
	Will the Minister consider having a system that flags up people who are 24/7 carers, so that when they need fast-track treatment they can receive it? That would save not just money, but misery and distress to the whole family. I therefore commend new clause 19(1)(d): its two lines could transform people’s lives. I ask the Minister to take this simple and practical step, which would make such a difference.

Robert Buckland: My amendments 27 and 28 are on safeguarding. Clause 42 contains a raft of measures that will go some way to enhancing the powers and role of the authorities in dealing with disturbing and worrying cases of abuse or neglect, which we hear about all too often when it comes to the care of vulnerable adults.
	Amendment 27 relates to the definition of abuse in clause 42(3), which rightly makes reference to financial abuse. We are all aware of the rising phenomenon of financial abuse, where older people and those with learning difficulties have been preyed on, sometimes by their own family, for financial gain. My worry is that, while a distinct reference to financial abuse is welcome, there is a danger of creating an imbalance that will make other forms of abuse less relevant or important.
	Statistics from the Health and Social Care Information Centre on the number of safeguarding referrals in the last year for which records are available show that the most common causes or types of abuse are physical abuse and neglect. My concern is that they do not appear in the Bill. It would perhaps be better to have an amendment, along the lines of the one I have tabled, that acknowledges different types of abuse and refers the matter to guidance that could be carefully and comprehensively drafted, so that practitioners can be safe in the knowledge that one type of abuse does not take precedence over another. This is an issue that has been raised in the other place and in Committee here. The Government have said they are concerned that defining abuse further might restrict the scope of a local authority’s duty to inquire, but my concern, and the concern of organisations such as Mencap, is that not having a reference to other forms of abuse might lead to an undue focus on financial abuse only, to the detriment of others.
	Amendment 28 would place a duty on relevant partners, such as those providing care and support, to notify the local authority if they believe an adult is at risk of abuse. It is clear that local authorities cannot be expected to identify all types of abuse themselves, or to rely on the good will of other people or agencies. If relevant partners, including providers of care, had a duty to report that adults were at risk of abuse, that would make their responsibilities clear, and would help to secure greater transparency. I, and others, fear that leaving the matter to guidance would pose a risk that the duty would not be taken seriously enough. A legal duty for relevant partners has already been introduced in Wales, and the amendment seeks to mirror that.
	We are familiar with the existing framework relating to adult safeguarding boards and the joint agency working that takes place, but concerns that arise day in, day out
	are not always reported, and, sadly, there is also under-reporting of concerns from hospitals. While there are many examples of local excellence in the development of safeguarding procedures, I fear, as do others, that there will be too much of a patchwork and not enough of a national framework. It is essential for us to know, wherever we live, that the standards of reporting and obligations placed on agencies and other partners to make that all-important report about abuse are consistent. Because adults are often much more isolated than children and young people who are surrounded by a framework, a duty to report when an adult is at risk could be considered to be more crucial.

Emma Lewell-Buck: I shall speak briefly about new clauses 17 and 18 and amendments 31 to 33, which stand in my name.
	New clauses 17 and 18 go to the heart of the social care profession. They say a great deal about how much we value the care of vulnerable and older people. New clause 17 would reveal the full extent of poor employment practices in the care sector, including zero-hours contracts and failure to pay the national minimum wage. Good social care thrives on the provision of well-trained, motivated staff who can develop proper relationships with the people whom they visit, but we know that that does not happen. According to the Social Care Workforce Research Unit, more than 150,000 people in the care work force earn less than the national minimum wage. Poor pay not only affects employee morale, but makes it difficult to attract skilled staff and encourages high staff turnover. None of that is good for service users, who need to have confidence and trust in the people who visit them.
	The Government promised to get tough on employers who do not pay the national minimum wage, but so far only five employers have been “named and shamed”. Not one of them was in the care sector, which is worrying given how widespread we know the problem to be. New clause 17 would give a clear picture of the state of the sector, and would create a foundation for possible action.
	New clause 18 would create a requirement for local authorities to consider how the employment practices of providers they commission might affect the quality of care. The aim is to build checks into the system so that standards are not allowed to slip. Training is a particular concern: more than 40% of respondents to a Unison survey reported that they had not been given specialised training to deal with the specific needs of clients with conditions such as dementia. Nearly a quarter reported that they were required to carry out medical procedures or give medicine to clients when they had not been trained to do so. More worryingly, a care worker who spoke to me recently told me that it was standard practice in the agency to leave tablets for clients by their bedsides to save the cost of another visit later in the evening to ensure that the client had taken his or her medication. That means, essentially, that hundreds of vulnerable, confused people who are not in control of their own care are left to control their own medicine.
	The issue of 15-minute care visits has rightly attracted considerable attention, not just because they often make the practicalities of care impossible, but because they eliminate almost any chance for a relationship to develop between carer and client. An under-reported crisis among
	older people is growing isolation, and the carer may be the only person to whom many of them speak on most days. That has real, measurable impacts on people’s well-being, and is made worse by those flying visits. New clause 18 would force authorities to take such factors into account when commissioning services.
	A care worker on a zero-hours contract told me that it was common for 15 or 30- minute visits to be scheduled back to back, which gave him time to do only the bare minimum. He had no time to speak to his clients, or to go the extra mile to keep them comfortable. He often drops in on them in his spare time just to ensure that they are okay. On one occasion, he arrived at a client’s home to find that the man had fallen and needed to go to hospital. The man asked whether the care worker—a constituent of mine—could go with him, and my constituent rang his employers to see whether that was possible. He was told that it was not. It is extremely worrying to see cases in which social care has lost that basic element of compassion. Employers must be required to build some kind of flexibility into their practices.
	My own experience in adult social care has convinced me that a general duty of well-being is simply not enough.

Madeleine Moon: Because of the local government cuts, people are no longer thinking about that general duty of well-being. What is almost a “something is better than nothing” attitude has crept in and replaced concern for the well-being and care of the individual, who should be receiving quality care.

Emma Lewell-Buck: I entirely agree. The budgets of council adult social care departments are now so stretched that they fill a gap wherever they can, as cheaply as they can.

Andrew George: The hon. Lady is making an excellent point. In new clause 32, I propose that the Secretary of State should undertake a review of care standards, including hourly pay and other kinds of remuneration for home care workers. Does she agree that unless we have decent national standards for visiting times and remuneration, we shall be faced continually with a race to the bottom?

Emma Lewell-Buck: I apologise for not having read the hon. Gentleman’s new clause. I have been focusing on my own new clauses and amendments, but I will look at his new clause at a later stage.
	Amendments 31 to 33 would establish firm time scales for assessments and reviews of service users’ care needs. During the Bill’s passage so far, the Opposition have repeatedly tried to raise the issue of the funding gap in adult social care, which threatens some of the positive changes that the Bill would bring about. In my constituency, our local authority has been forced to make £24.3 million-worth of savings, with predictable consequences. One of the consequences for local authorities has been a decline in the regularity of assessments and reviews. I have spoken to people whose assessments have been grossly delayed; I have also visited care homes in which some residents have not been reviewed for up to three years, during which time their needs may have changed dramatically and their support may have become inadequate.
	It is easy to understand how that happens. Under-resourced departments must set priorities, and routine steps such as the reviewing of someone’s care plan are often at the bottom of the list because there is no pressure for them to be taken in a timely way. However, those steps are very important, because they identify changes in a person’s condition which, if ignored, might lead them to a crisis point. The amendments would reverse a worrying trend which has seen delayed assessments rise significantly since 2010, when 18.7% of new clients waited four weeks or more for an assessment. By 2011-12, the latest year for which figures are available, the figure had risen to 22.7%. In some individual local authorities, the change is even more worrying. In one authority, the number of new clients waiting to be assessed jumped from 12.6% to 70.7% between 2010 and 2012. It is important to remember that those are not just percentages, but represent vulnerable people whose needs are not being met.
	In Committee, the Minister said that he was concerned about assessments being rushed to meet the timetable, and that a simplistic time scale would not be tailored to meet individual needs. I agree that that is of concern, but it should not be necessary for the time scale drawn up by the Secretary of State to be a “one size fits all”. The timetable for more complex cases could take into account the more complex nature of the assessment and allow more time for completion. It would be much more dangerous to have no benchmark at all and for those people to have their assessments delayed and their needs not met. The amendments would improve the situation for people with more complex needs, for whom putting support in place quickly is most important.
	The Minister made two points on reviews: that a “regular” review would be too rigid and would impose an arbitrary time scale on clients whose needs might be very different from each other; and that clause 27’s introduction of a right to review on “reasonable request” would guard against the problem of clients going unreviewed for long periods. I do not believe that a timetable would need to be so rigid. As with assessments, the timetable would not need to be identical for all patients regardless of need. During the consultation, the severity of individual conditions could easily be addressed, as could other factors such as age, to ensure that local authorities use their time most effectively. A properly formulated time scale would not have the disadvantage of inflexibility that the Minister suggests. I hope he will agree that only through legislation can we really motivate local authorities to conduct a review in a timely manner.
	On the Minister’s second point, I agree that a right of request is a step forward, but I worry that it does not address all, or even the majority of cases. Many of the people we are talking about live alone, or have issues with mobility or communication. They do not have a family member or other permanent carer to be an advocate on their behalf. Establishing a firm timetable would ensure that those people are not overlooked.
	The Minister said in Committee that the Government would produce indicative time scales for support plans and reviews. Although that is helpful and shows that the Government recognise the problem, I do not think that indicators will provide enough motivation for local
	authorities to get on top of the issue. As I have explained, a measure already exists to show how quickly initial assessments are conducted. A measure also exists for reviews to be proportionate, but neither has stopped the gradual slide in performance of recent years. Informal measures simply do not carry much weight.

David Ward: I will try to hit my five-minute target by excluding a lot of other comments, including on the eligibility criteria, which I have spoken about at length on other occasions.
	The shadow Minister, the hon. Member for Leicester West (Liz Kendall) effectively made the case about the false economy, whereby the criteria are at the wrong level and people’s conditions deteriorate, so they and the state face a greater cost. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) referred to the provision to identify patients who are or may become carers. I am concerned about carers who end up becoming patients or needing care because of a lack of support. We need to consider that, too.
	I will confine my comments to new clauses 7 and 9. Without those, the rest is almost irrelevant. My right hon. Friend referred to the elephant in the room. An elephant in the room is something we are vaguely aware of; we know it is there but we are not prepared to talk about it. Out there, people are talking about the crucial issue of whether these services can be afforded. So much in the Bill is so good, but we are in danger of casting doubt on the deliverability of what we know is good and on whether it can be implemented.
	As is often the case, it is no use relying on the good old principle of localism and local authorities making the decision to pick up these things. There is a difference between localism that is freedom and localism that is an abrogation of responsibility by Government to fund services during a national crisis. If we get that wrong, we will simply give local authorities the freedom to fail. We need to ensure that that does not happen.
	The sad thing is that, although there is so much good will out there for the Bill— we are in grave danger of not responding to the comments of the voluntary and community sector and the public sector generally on the principles of the Bill and many of its provisions—there is a suspicion that, at the end of the day, we cannot deliver on it. The question is why would we not support new clauses 7 and 9. We are asking for assurances, not for additional money, because the truth is we do not really know. We are asking for assurances through a review. We are asking not for additional funding but for a commitment to a review.
	I was going to give a grand finale about the voyage into the unknown, but it is not unknown, is it? We know that huge demands will be placed on the system and that that will have grave implications for many people who are receiving and providing care. We know that that is on the way. We think we have a system in place through the Bill that will enable us to deliver on that. The big question is not an elephant in the room. The groups that I am working with on the Bradford Cares projects, Age Concern, Mencap, Scope and the Bradford and District Disabled People’s Forum say that this is good and they like so much of the Bill, but they raise their eyebrows and say, “Will the funding be there?” That is the big question that is asked over and again. Through new clauses 7 and 9, we can at least give them
	some faith that we recognise that it is a big issue and that we are seeking to identify and meet our responsibilities to fund what we all want to do and see.

Barbara Keeley: In introducing new clause 3, the right hon. Member for Sutton and Cheam (Paul Burstow) said how he felt that the NHS institutionally must change to identify and support carers. Of course I agree with that. My hon. Friend the Member for Leicester West (Liz Kendall) introduced new clauses 19, 20 and 21. She mentioned my private Member’s Bill, which I feel is having its last outing today in these new clauses; it proposed measures on the identification of carers. I want to touch on how long these issues have been around.
	Eleven years ago, I completed a project on identifying and providing support for carers and co-wrote a report on that. The report made recommendations to Government, NHS bodies, GPs and their teams on how important it was to identify and support carers. That project mapped 36 primary care support initiatives for carers run by the Princess Royal Trust for Carers. We are talking about a long time ago. We felt that the role of carers, including their contribution to the work of the NHS, had generally been under-recognised and under-valued.
	Through the 1990s, to the point where I wrote that report, we had carers assessments following the excellent Carers (Recognition and Services) Act 1995, introduced by Malcolm Wicks. That was strengthened by the Carers and Disabled Children Act 2000, which enhanced the carer’s right to an assessment. We even had in 1999 standard 6 of the national service framework for mental health, which said:
	“all individuals who provide regular and substantive care for a person on the Care Programme Approach should have an assessment of their caring, physical and mental health needs, repeated on at least an annual basis”.
	Even at that point, the Department of Health said that the implementation of the carers’ right to an assessment four years in was
	“patchy. Assessments are not always carried out. Some carers are offered very sensitive practical and emotional support. But others receive very little, or no help”.
	Fast-forward 15 years to the Care Bill, and carers are still in a similar situation. The identification of carers and referring them to sources of advice and support is still not happening on an adequate scale, and we have had all that legislation and good practice. Carers UK has told us that two thirds of carers that it surveyed said that, although their GP knew they had caring responsibilities, their GP did not give them any extra help. We have heard examples of what that can mean.
	Carers week is in June, and we look forward to that. We know that in that week we meet carers at events. There is a common theme: they tell us repeatedly they are not getting advice and information to help them care. They can be carers of people with cancer, carers for people with terminal illness, carers of people with Parkinson’s or of people with dementia. Does the Minister want to start changing that for carers week this year? Does he want to go along to carers week events and have carers start to say to him, “I have been identified by my GP and my GP does recognise my caring role”? I hope he does, because I have heard so many people say how much it would have meant to them and what a difference it would have made to their caring if their GP had recognised it.
	Even for conditions such as Parkinson’s, only one in 10 carers has been offered an assessment. These are people who are caring very often more than 50 hours a week, and, as a disease such as Parkinson’s progresses, up to 24 hours a day. They and the people caring for somebody who has had a stroke or who has dementia are the people who really need advice, support and breaks. These are the reasons we must support new clauses 3, 19, 20 and 21.
	The Care Bill puts great emphasis on carers assessments rather than on the identification of carers, and I introduced a private Member’s Bill on that in September 2012. The clauses in that Bill, which we see again today, would have ensured that NHS bodies had procedures in place to identify carers and to promote their health and well-being and ensure they receive information and advice. I believe the key reason in identifying carers should be because we have a concern for their health, particularly those with the heaviest caring commitments. That is one in five of all carers, and that is more than 1 million people, which is just too many.
	Those caring for more than 50 hours a week are twice as likely to suffer ill health, particularly those caring for a person with dementia or stroke. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) has just talked to us meaningfully and movingly about the impact of that caring role on her family. We want early identification and support for those carers so they can maintain their health and manage and sustain their caring role. I agree with my right hon. Friend that they should be fast-tracked for appointments. As hopefully we move towards integration and, beyond that, whole-person care, local authorities cannot be expected to act alone to identify and support carers.
	As has been touched on in this debate, we also have to face the fact that the number of people receiving social care services is shrinking. In Salford this year, because of budget cuts, 1,000 people are going to lose their eligibility for social care services and 400 people who would have become eligible for care will not become eligible. The unpaid carers in those families will be taking on that substantial burden, yet, sadly, the GPs and doctors around them will not identify them, will not help them, will not make sure they get advice and support.
	This Care Bill is the place to make the change, and I say to the Minister let us not wait another 15 years to make the change and place such a requirement on health bodies—and schools, universities, colleges and further education colleges in the case of young and student carers. Let them just have policies in place to identify carers and to provide support for them.

Sarah Wollaston: I would like to speak briefly to new clauses 1, 26 and 9. I hope new clause 1 on the adult safeguarding access orders would rarely ever be necessary because, as the Minister knows, the vast majority of carers are out there day in, day out, night after night providing dedicated care, often at the expense of their own health. There is a tiny minority of people, however—and I am afraid I have met some of them—who are coercive, controlling and manipulative, particularly if there is money at stake. At the moment there is no right of entry even if other relatives or neighbours and friends have raised concerns, and even if clinicians have concerns. Of course in most cases a
	negotiation can take place and access can be gained, but very often that access is only with a rather controlling person in the room as well, and it can be very difficult to make a full assessment of capacity under those circumstances, as I am sure the Minister is aware. There are people who are at risk. We know that 29 local authorities have identified that there have been vulnerable adults for whom they have been unable to gain access.
	New clause 1 is about stating that there needs to be a final backstop in circumstances where it is clear that the safeguarding of a vulnerable adult at risk is paramount. I know there are those who say we already have right of access under the Police and Criminal Evidence Act 1984, but unfortunately the bar is set too high and there is uncertainty about the ability to gain access. New clause 1 sets out very clearly the thresholds, and also the safeguards, because this is not about riding roughshod over individuals who do not wish to have a social worker entering their home. Instead it is about setting out the rights of an individual who may be under the control of a coercive third party. We need to have greater clarity and I hope the Minister will consider this new clause. Having a final backstop works well in Scotland; it is very rarely used but we need to have it in place as a final resort.
	On new clause 26, I asked the Minister to imagine a circumstance when he might have crushing central chest pain and the ambulance takes him not to a casualty department but to a police cell because a cardiologist is not available to make the assessment or a bed is not available on a coronary care unit. That is completely unthinkable yet that is the reality in the UK for people experiencing a mental health crisis. It has gone on for far too long. I am perhaps one of the few Members of this House who has been in a police cell in the middle of the night because I was a forensic medical examiner for several years. These are extraordinarily scary places for anyone, let alone an individual experiencing an acute mental health crisis.

David Burrowes: I, too, have had experience of being in a police station, as a duty solicitor in my case, and therefore have seen for myself that the very last place these most vulnerable of people should be is a police station. Given that the Government have made commitments—indeed, financial commitments—on a diversion service, to ensure that the principle of diverting these vulnerable people is recognised, surely the next step is to support the principle of my hon. Friend’s new clause?

Sarah Wollaston: I thank my hon. Friend for those comments and I welcome the mental health crisis care concordat, and what is being done to emphasise that prevention is by far the best way forward, but even with those prevention measures in place I think we would all accept there will still be circumstances where people will reach crisis, and unfortunately a police station is absolutely the last place anyone, let alone a child, would wish to be in crisis. In Devon and Cornwall alone, 27 children last year were taken to police cells for long periods of time. On three occasions those children were as young as 12 and 13. That is simply unacceptable. One of the reasons it is likely to continue is that there is no penalty currently for the NHS in continuing to use such facilities. It does
	not have to pick up any of the financial tab. That is putting enormous pressure on our police forces. They do not wish this to happen, of course. If we cannot at least have this sunset clause, which I think is eminently sensible, I hope the Minister will consider making sure that the NHS has to pay to use the police cells, and that there is a significant financial penalty, because that would be a driver. That would make it financially much more sensible for the NHS to put in place measures for these vulnerable people—who often have been found by the police at the point where they are about to take their own lives. It cannot be acceptable for this situation to continue.
	Moreover, the variation in such use of police cells is extraordinary. There are some areas where that is not used at all and others where it is very heavily relied on. I hope the Minister will say in his response that he is prepared to consider a sunset clause, or at least a financial penalty, so we see drivers in place and we continue to move away from such a practice. However, I absolutely recognise the point made by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) that prevention is far better, and I know all areas are working towards that and that the Minister fully supports it.
	New clause 9 is an extraordinary measure that is widely welcomed because of the principles to which the right hon. Member for Salford and Eccles (Hazel Blears) referred about well-being and prevention. These are at the heart of the Bill and everybody welcomes them. However, I think the Minister recognises that there could be unintended consequences if we were to introduce many new statutory obligations without their being funded fully. As he will know, we have two tests—a needs test and a means test—for people to pass in accessing social care, and 88% of needs tests are now set at a substantial level, which has been quite a considerable change. There is also the means test, which stands at £23,250. On many occasions as a GP, I remember coming across the absolute shock encountered by people when they realised that they would get no help whatever.
	The change under the Bill will be extraordinarily welcome, although we should be under no doubt about the burdens that it will place on local authorities, in particular in my area. Devon has the third oldest demographic in the country, but funding of local authorities for health care does not have sufficient emphasis on the age structure of the population. There will be great impact on Torbay and on other areas in Devon, such as my constituency.
	New clause 9 is a sensible measure about how we plan for the future and make an appraisal of whether we are fulfilling the important provisions in the Bill, ensuring that we have sufficient resources directed towards prevention and well-being. I hope that the Minister will see the new clause as helpful and as one that will assist us in planning for the future.

John McDonnell: I will speak to the amendments in my name. I share the view of the right hon. Member for Banbury (Sir Tony Baldry) that we should not have nodded the programme motion through blithely. Many of my constituents have contacted me about the Bill, because care in my area is on the edge of crisis, with the new threshold rolling it back for many
	people. That is why I support new clause 11; people need their human rights to be ensured in the Bill. New clause 2 is important, because we have a Children’s Commissioner and we need a commissioner for the elderly and other care services, so that there is someone to speak out for people. I support new clauses 7 and 9, because I agree that introducing legislation without funding is meaningless. We place local authorities in an impossible position, as they struggle to provide the services.
	With regard to the work force, we need to ensure pay and adequate training, so that we fully professionalise the work force. In my area, we have a high turnover of care workers, which leads to distressing results. In case, an elderly lady was burgled and on the next day a new carer came in, but she thought that she was being burgled all over again, because she did not recognise the person. That is the instability in the industry at the moment. That is why I support new clauses 17 and 18.
	On the amendments in my name, new clause 31 is generated by one of my constituents called Jonathan Kay, who asked me to get the matter dealt with in the Bill. For many years, Jonathan has been funded by the local authority to employ a personal assistant to enable him to carry out his day-to-day tasks—he is a disabled person—but he has experienced serious problems with personal assistants in the past, even suffering abuse on more than one occasion. When employing personal assistants, Jonathan has found assessing the suitability of candidates extremely difficult, and he has not been able to obtain reliable recommendations from any public body, despite using public funds to employ them.
	Part 3 of the Bill provides that the training and education —but no qualifications—of carers will be undertaken by Health Education England. The purpose of my new clause is for Health Education England to allow scope for the local education and training boards to do such work and to compile, publish and maintain a register of all persons who provide regulated social care for individuals under arrangements made by or paid for by a public authority. That would allow people such as Jonathan to access a list of trained professionals whom they can employ with confidence, we hope, in future.
	With amendment 26, I am simply seeking to install into the Bill a provision on the right to live independently, as recommended by the Joint Committee on Human Rights, but dismissed by the Government. The Government might well have been concerned about the legal actions that were taking place with regard to the independent living fund, but the Committee’s report made its disappointment very clear that the Govt had not taken the opportunity of the Bill to be explicit about their support for the convention on the rights of people with disabilities and article 19—“Living independently and being included in the community”—being a human right. It should therefore be included in the Bill. The Government have given assurances that the general direction of the Bill might achieve the same ends, but that is not good enough in that it does not enforce the rights in law.
	My amendment 21 covers the same ground as new clause 15, so I will not dwell on it in any depth, but I will give an example. Whether with our parents or in our community, we all know about the uncertainty of charges for residential care. They cause real concern and anxiety among families. Yes, the ability of local authorities to
	negotiate rates influences the overall market, but that is why there is a need for some form of indicative price. A care funding calculator is used to set the care of people with learning difficulties, and that model has worked and saved public funds. We should at least be considering in the Bill that sort of process for care overall.
	My proposals in amendment 20 would
	“require the local authority, when carrying out the assessment, to capture an individual’s main and other disabling conditions”.
	A whole group of organisations, including the Parkinson’s Disease Society, Sue Ryder, the Motor Neurone Disease Association, the Multiple Sclerosis Society, the Epilepsy Society, the Neurological Alliance and the Alzheimer’s Society, have all campaigned for this simple change in the assessment process, which merely requires local authorities to collect and record information about an individual’s main and other disabling conditions when they are conducting their social care assessments and arranging care packages. Why is that important? It is important for local authorities to be aware of the different conditions in their community, so that they can plan long-term services, but it is also important for us to be aware of the information nationally, so that care services and our investment can be planned in the long term. Taking that into account seems to be a minor amendment.
	Amendment 22, which I also tabled, was proposed by the Royal National Institute of Blind People and lobbied for by a number of my constituents. In clause 76, the duty is placed on the local authority to establish
	“a register of sight-impaired and severely sight-impaired adults who are ordinarily resident in its area.”
	The existing provision relates only to adults and does not include children. My amendment simply ensures that the local authority is required to collect information on both adults and children. The reason for this is that, under the Children Act 1989, there is a requirement on local authorities to collect information with regard to blind and partially sighted children, but 20% of local authorities admitted failing to meet that legal requirement. Furthermore, 20% of local authorities have no register; three councils include just 1% of disabled children known to the authority on the registers; one in four authorities have whole registers with fewer than 2% of disabled children known to the council; and almost six in 10 councils include 10% or fewer of the disabled children. The RNIB therefore emphasises that in clause 76 we should place on local authorities a duty, when collecting information, to include children ordinarily resident in their area. Again it is the same mechanism; it is about the planning of services to ensure that they are properly invested in over the long term.
	Overall, I welcome the Bill, but I fear that it will disappoint many as a result of the failure to address some of the considerable issues with regard to funding, rewards to the work force and professional training, and the appropriateness of the cap on costs.

Sheila Gilmore: I am pleased to have the opportunity to speak to new clause 5, which is in my name. I thank the many Members who have supported the clause.
	I have been pursuing the issue since 2011, initially on behalf of a constituent, a Mr Kenny, who suffered an injury when he was serving in the Army and is paralysed from the waist down. He originally lived in the London
	area, but his family is from Edinburgh and he wanted to move back to his family. For four years, he got absolutely nowhere, because neither authority would take responsibility for him being able to move. They argued backwards and forwards. Eventually, his family helped him to move physically, but for a period none of his care costs was being met, until Edinburgh relented and began to meet those costs. By that time, he had incurred quite a lot of debt.
	I first raised the issue in 2011. The right hon. Member for Sutton and Cheam (Paul Burstow), who was then the Minister, said that it should be covered in the White Paper, but when that came out it only related to portability of care within England and not to the devolved authorities. I kept raising the matter and I was assured that something would be in the Bill, but when it was published the measures related to the portability of residential care packages but not home care packages.
	I did not serve on the Public Bill Committee, but I know that this matter was examined there. Warm words have been spoken, but I tabled the new clause because I hope to tie the Government down to a timetable. I want them to make some progress and report back in six months on what further legislative or regulatory changes are needed to make this portability of care a reality; I do not want this to keep being argued backwards and forwards, as has happened for such a long time. As my new clause is modest, I hope the Government may be prepared to accept it at this stage, so that six months after Royal Assent we will be coming back with practical steps that can be taken to move this on. In that way, I hope that people such as Mr Kenny will not in the future be faced with having this argued over their head, with their not being able in the meantime to have the care they need—care near to their family, which of course will probably, in the end, result in a saving to everyone.

Grahame Morris: I echo the sentiments of other hon. Members about the lack of time we have been allocated. I appreciate that it is not your fault, Madam Deputy Speaker, but we have so much to get through and the shortage of time means that although I would like to speak in support of a raft of amendments and new clauses, I will limit my remarks to a discussion of new clause 9.
	I am supportive of the Care Bill—changes that make care simpler and fairer are to be welcomed—but there are real concerns about the sustainability of the changes this Bill seeks to make. I do not doubt the integrity and good will of the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), but with all the good will in the world the proposals in the Bill can be implemented successfully only if they are properly funded.
	Other hon. Members have raised concerns about the funding implications, and the original Dilnot report, one of the foundation stones of the Bill, made it clear that insufficient funding would hamper the effectiveness of any attempts to implement reforms, including the ones in this Bill, and that long-term social care funding will work only if the current crisis in social care is addressed first. So we must not forget that the success of the Bill will be jeopardised by laying reforms over a
	system that is underfunded. I do not have time to go into the figures, save to say that adult social care budgets alone have been reduced by £2.7 billion over the past three years—that amounts to 20% of average council budgets.
	The impact of such cuts is compounded by rising demand resulting from demographic changes. It has been estimated that to meet the demographic pressures the nation needs to spend another £400 million a year. So local government has real concern that the implementation costs and ongoing running costs of the reforms being implemented through this excellent Bill have not been fully costed and will not be funded, other than as new burdens.
	It is unacceptable—and it will damage public confidence and trust—to pretend that new standards will be able to be met if the resources are not in place to deliver them. That is why it is so important that an additional reporting mechanism is in place, such as new clause 9 would establish, to provide assurance that the social care system and reforms in the Bill are adequately funded. If the Government really intend the Bill to be their flagship piece of legislation on social care, we need to know that the numbers add up. Despite councils’ best efforts to protect front-line services, the reality of cuts on this scale has meant that adult social care has not been immune to their impact.
	A number of hon. Members have indicated the scale of the impact in their own areas, but the eligibility criteria level for social care has risen dramatically across a range of authorities. It is unclear how the new eligibility threshold will work in practice, both in terms of the effectiveness of care that older and disabled people will receive and the impact that the threshold will have on local government finances. But it is a concern that an eligibility threshold set at “substantial” will, as the hon. Member for Totnes (Dr Wollaston) has said, fail to create a preventive care system—that is what we all want, along with well-being.
	A failure to create a preventive care system could result in a false economy in the long term—my hon. Friend the Member for Leicester West (Liz Kendall) mentioned the figures from the Deloitte study. By not delivering the £1.2 billion of investment needed to lower the national eligibility threshold, central Government could be missing out on savings as great as £700 million. The well-being principle of the Bill will fail to become a reality as many old and disabled people will be ineligible to have their needs met, so it is important that the effectiveness and sustainability of the eligibility threshold is reviewed and changed when appropriate.
	We have a unique opportunity to improve care, which is why I am in favour of establishing the joint care and support reform programme board set out in our new clause 9, which provides for a report on performance and implementation. A failure to do so could render the well-intentioned reforms in the Care Bill meaningless.

Bill Esterson: Social services are under huge funding pressure, which has a knock-on effect on the NHS. New clause 9 highlights the crucial issue of funding and will contribute to addressing it. Just 10 days ago, I experienced at first hand those pressures on the NHS. I would have added my name to
	this new clause, but I was unable to be here because I spent three days in Southport and Formby district general hospital. I saw the pressures in the accident and emergency department resulting from beds not being available for the transfer of patients to the wards; the pressures arising from chronic staff shortages; the difficulty in helping patients to return home because of a lack of support in the community; and general practitioners sending older people to A and E with complex needs as there was a lack of other choice or care available. In large part, the cuts in social services funding meant that I saw all those things. Meanwhile, staff in the NHS are working incredibly hard, often doing double shifts to look after patients, for which I am extremely grateful, as are many others. I take this opportunity to thank them and everybody in the ambulance service for what they did for me and have done for many other people.
	The evidence I collected during those three days shows just why we need to be confident that funding is in place. Unless the funding is adequate, both in social care and in the NHS, the challenges faced day by day, hour by hour in our NHS will grow worse. We need greater integration, provided through the all-party approach advocated by Sir John Oldham in the report by his Independent Commission on Whole Person Care. As the report says, practice needs to move on so that we can see more care provided at home, with professionals working closer together in the interests of the individual. The whole-person care approach would reduce the number of hospital admissions; it would keep more people at home for longer, reducing hospital admissions and avoiding the huge pressures that I witnessed. In the context of the Bill, we need to be confident that the funding is sufficient to deliver the new responsibilities, which is why we tabled new clause 9. I hope that Members will support it this evening.
	New clause 19 calls for health bodies to promote the health and well-being of carers. As the independent commissions report states:
	“Most care is delivered by people themselves and their families.”
	That makes the health of carers vital. My dad cares for my mum, and his health is a major concern. Carers up and down the country face declining health as they care for loved ones. Caring for the people who care is also a vital aspect of care provision, and paid staff in the health and social care sectors are also carers. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) talked about priority treatment going to volunteer carers—family members, friends and other volunteers. We should also consider that approach for everyone who works in the NHS or in social care. If we read the new clause in its widest sense, we should consider paid carers too, be they in the NHS or in social care.
	Some 1.3 million people work in the NHS, and 1.5 million in social care. We should promote the health of NHS and social care staff as well that of unpaid carers who do a fantastic job up and down the country. I hope that new clauses 9 and 19 receive the support of the House.

Norman Lamb: I share the frustration of many Members at the shortness of time that we have had to discuss such important issues.
	Part 1 of the Bill brings in a long overdue and fundamental reform of care and support. It has been brought before the House after around five years of one of the most collaborative processes ever used to develop legislation, and I am very proud of this historic set of reforms.
	I hope to have time to explain Government amendments 1 to 7 and 14, relating to clause 123 on regulations, but before that I shall try to address some of the key points that have been made. I fear that I do not have time to do justice to all the points, but I shall do my best.
	On new clause 1 on power of access, which was tabled by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), it is my view that there is no gap in powers that would prevent care or other professionals from accessing those in urgent need of assistance. I am not alone in that view. The Association of Chief Police Officers says:
	“Powers of entry are provided to us under both common law and PACE and I am satisfied that these would afford us access to premises where vulnerable individuals are considered to be at risk.”
	The Association of Directors of Adult Social Services, which is an important organisation, agrees:
	“We have no evidence that the proposed powers of entry would add significantly to the range of tools currently available to practitioners, rather we are concerned that this would encourage a coercive rather than negotiated approach to complex and difficult situations, and increase risk of harm or abuse. Any such power would not assist the complex next steps in assuring and supporting individuals, who have capacity, to stay safe.”
	That view is confirmed by the chief social worker for adults, who said:
	“An additional power of entry or access on its own would be insufficient, and indeed could make the situation worse.”
	The inherent jurisdiction of the High Court to intervene provides a crucial final safety net. Beyond that, the critical thing is to issue, as we intend to do by the end of March, clear guidance on existing powers to ensure that all professionals working in this important area understand what powers they have available to them. I know that my right hon. Friend has been assiduous in pursuing that issue, and I am happy to involve him in the process of confirming those final guidelines that we intend to publish by the end of March.
	On amendment 27 about the definition of abuse, the Joint Committee on the Draft Bill stated:
	“Abuse is an ordinary English word, capable of being understood without being defined…to attempt an exhaustive definition always has the danger of omitting something which, as subsequent events make clear, should have been included.”
	We agree and believe that the Bill is clear as drafted. Last week, I spoke to the all-party group, which is chaired by my hon. Friend the Member for South Swindon (Mr Buckland). I promised to go away and look at the matter and to talk to officials, but I am absolutely satisfied that the plain English words are very clear. The explanatory notes will be expanded to ensure that it is made clear. The guidance and explanatory notes will both have legal force, and courts will use them to interpret the intentions of the Bill.
	Turning to amendment 28, the overarching well-being principle applies to safeguarding duties. Where partners become aware of abuse or neglect, it is imperative that they act, and the guidance will be absolutely clear on that point.
	On new clause 26, I completely agree that police cells are a totally inappropriate place for someone in a mental health crisis. The crisis care concordat, which, for the first time ever, sets standards of crisis care, lays out our clear expectation that the use of police cells will drop by half by 2014-15. However, that must only be a start. The Home Secretary announced last year that there will be a review of the operation of sections 135 and 136 of the Mental Health Act 1983 on places of safety, and that is the right approach to take. However, I agree that we must end this awful practice of people ending up in police cells completely inappropriately.
	I sympathise with new clause 11 on the Human Rights Act, but do not feel that it adds anything in terms of protection for individuals. None the less, I recognise the strength of feeling on the matter, so I expect that it will be discussed further in the final stages of the Bill’s passage in the other place. In the meantime, I am prepared to reflect on the points made and consider whether legislative clarification might be justified in order to make the Government’s position clear.
	On new clause 2, I sympathise with the case for an older person’s commissioner. I have communicated with the Care Quality Commission, Healthwatch England and NHS England to ensure that the organisations that are responsible for functions that guarantee, or seek to guarantee, good care for people take absolutely seriously their responsibilities towards older people. I have had initial responses that I am happy to share with hon. Members. I am also happy to set up a round table meeting with our system partners and interested parties to discuss this matter further if that would be helpful.

Paul Burstow: That is a helpful way forward, but I ask the Minister to say a little bit more about new clause 11 and the Human Rights Act issue.

Norman Lamb: I have already confirmed that we will return to the matter later in the process, and I hope that we will then end up in a satisfactory place.
	Turning to new clauses 7 and 9 to which a number of hon. Members have spoken, the spending review considers spending pressures across adult care and support, the NHS and public health. In the current spending review period, we allocated significant additional funding to local authorities for adult care and support, including a transfer from the NHS of £1.l billion a year by 2014-15 to be spent on social care with a health benefit. That is not to say that I do not recognise how challenging the financial environment is for local authorities, but we know from figures provided by the local authorities themselves that the vast majority of cost savings have been achieved as a result of efficiencies and not of cutting services for people.
	However, as the hon. Member for Leicester West (Liz Kendall) said in Committee, the answer is not just to throw more money at the system, but to look at how public funding is spent and to deliver a more radical reform of health and social care. That is why, in the spending review for 2015-16, we announced the better care fund, which is a £3.8 billion pooled budget for health and social care. That not only provides the resources needed to protect access to social care, but
	breaks absolutely new ground in establishing structures that will drive further and faster integration between health and social care.
	As hon. Members have noted, the better care fund includes £135 million of additional funding for implementing the Bill in 2015-16. Some have argued that including that in the better care fund means that local authorities will face a choice between implementing the Bill and investing in integrated services. In my view, that is a false choice. On the contrary, our reforms are part of the same agenda, and we cannot afford to see those as separate issues. Both systems need to work more effectively together to help people live independently for longer.

Barbara Keeley: rose—

Norman Lamb: I am conscious that I owe it to hon. Members to respond to all the issues that have been raised.
	The reforms in the Bill to extend assessments and support for carers can play a big part in keeping people out of hospital. The spending review provided £335 million in 2015-16 to help local authorities’ transition to the capped cost system and to offer universal deferred payments. Locally, health and wellbeing boards have a statutory responsibility to analyse current and future health and care needs and to develop a strategy to address them. Given such an approach, there is no need for the proposed amendments.

Paul Burstow: rose—

Norman Lamb: I am sorry; I must ensure that I get through all the amendments.
	On new clause 13, I am clear that the current lack of good information on deferred payment agreements is not acceptable, given the importance of the scheme. That is why we are working with national partners in local government and the National Association of Financial Assessment Officers to develop a range of questions that will improve and expand the data we already have. The new clause is therefore unnecessary as we already have plans under way to achieve a similar goal.
	On new clause 4 on local authorities making “reasonable charges”, the Government’s proposal to set a clear amount beyond which a person’s income cannot be reduced is much clearer and provides stronger protection. I have written to my right hon. Friend the Member for Sutton and Cheam and other Committee members on this subject, and I would be happy to share the letter with other Members. I have nothing to add to that analysis and do not agree that the new clause is required.
	On amendment 21 and new clause 15, the Bill makes it clear that local authorities must work to maintain a sustainable market that delivers a wide variety of high quality services for people who need care and support in the local area. Local authorities’ own commissioning is an important part of this process. Additionally, local authorities will have to have regard to the well-being of individuals when commissioning services. Therefore, any local authority that commissions inappropriately short care visits or does not consider the actual cost of care when setting fee levels is highly unlikely to be fulfilling their duties. These matters will be set out fully
	in statutory guidance. It would not be appropriate to have a nationally set formula that would lead to standard rates or “tariff prices” for care and support, as this is best left to local negotiations in the open market.
	On new clause 24, local authorities are already under a duty to work with their local clinical commissioning groups and others through the health and wellbeing boards to undertake joint strategic needs assessments and to develop joint health and well-being strategies. Statutory guidance published in March 2013 makes it clear that these must be published and have specific regard to
	“what health and social care information the community needs, including how they access it and what support they may need to understand it”.
	Awareness-raising will be an important part of the Bill’s implementation. The Department will co-ordinate involvement of wider interests, including local authorities and the private and voluntary sectors, to raise the public’s awareness of the new arrangements, specifically on the need for people to plan for care costs. We will add to what is already available to monitor the effectiveness of information and advice, public accessibility and public awareness.
	On new clauses 22 and 23 about financial advice, the Financial Conduct Authority already has a responsibility to keep under review the financial advice market as regards how it is serving customers, and qualifications for advisers, and this includes those looking to fund long-term care costs. These requirements are published in FCA rules. Such an addition to the Bill would therefore be unnecessary.
	I understand the intention behind new clauses 17, 18 and 32—it is to ensure fair payment for care sector workers. In response to the Cavendish review, statutory guidance for the Bill will include guidance to local authorities on commissioning services and arranging contracts that will explicitly require them to have regard to ensuring that provider organisations adhere to minimum wage legislation, including, crucially, the payment of travel time between social care visits. We are also working closely with Her Majesty’s Revenue and Customs to ensure that the national minimum wage guidance is appropriate to the care sector. We have amended the Bill to enable specified bodies to provide training standards for groups of workers, initially focusing on health care assistants and social care support workers. This will form the core of the new care certificate.
	New clause 31 is outside the remit of Health Education England, which has a delegated duty under the National Health Service Act 2006. The duty relates to education and training in relation to persons working, or considering working, in connection with the provision of services as part of the health service in England. The duty does not extend to regulated social care, which is taken to mean social care delivered by providers registered with the Care Quality Commission.
	On new clause 5, given the inherent complexity presented by the different legislative frameworks operating in the different territories of the United Kingdom, we will look to develop principles on cross-border continuity of care that achieve the same practical effect as further legislation. I absolutely agree with the hon. Member for Edinburgh East (Sheila Gilmore) about the importance of this issue. We have started discussions with colleagues
	in the devolved Administrations and we will aim to publish the principles by November. I hope that that helps her.
	On new clauses 3 and 19 about NHS work to identify and promote the health of carers, I can confirm that the guidance will absolutely reinforce the importance of co-operation between the NHS and local authorities on local authorities’ duty to identify carers. NHS England is developing its own action plan for identifying and supporting carers. In addition, our vision for out-of-hours hospital care, which will be published in April, will build on changes to the GP contract for 2014-15. All patients aged 75 and over will have a named accountable GP with responsibility for their care, and we will consider how we can extend this approach to all people with long-term conditions. The plan will emphasise the importance of GPs identifying carers and supporting them in their caring role by directing them to information, advice and support.
	On new clauses 20 and 21, a legislative approach that compels schools, universities and colleges to identify young carers and student carers would not be in keeping with the Government’s drive to reduce burdens. The Department for Education has already been doing a lot in this regard, and it is now working with the National Governors Association in raising awareness in schools. The Department of Health has invested in many initiatives to help to identify and support young carers. We have trained over 150 school nurses as young carers’ champions. Along with other Departments, we will also explore the factors that are challenging in young adult carers’ transition from school to college or university. Along with ministerial colleagues, I will shortly write to Universities UK and the Association of Colleges to seek their engagement in this work.
	Amendment 20, tabled by the hon. Member for Islington North (Jeremy Corbyn), is not required because the scope of the new powers in clause 12 already allows for the collection of such information if we choose to require it.
	On amendments 31 to 33, we have carefully considered the issue of time frames in the care planning process, including reviews. On balance, we feel that a flexible approach is best. It is important for local authorities to retain the ability to be proportionate to the needs to be met. For some people—[Interruption.]

Eleanor Laing: Order. The Minister must be heard. Hon. Members are being rude in speaking.

Norman Lamb: Thank you very much, Madam Deputy Speaker.
	For some people, the care planning process may be relatively simple, but for people with complex needs it is important that the plan is carefully produced and agreed with the person in order to meet their care and support needs effectively and appropriately.

Emma Lewell-Buck: Will the Minister give way?

Norman Lamb: I do not have time, I am afraid.
	We will set out in guidance best practice on conducting care plans. I hope that that reassures the hon. Member for South Shields (Mrs Lewell-Buck).
	Amendment 26 is unnecessary because the concepts of independent living and inclusion in the community are already core parts of the duty to promote individual well-being. We have merely captured them in more concrete ways rather than using those terms, which are too unclear, as the Law Commission agreed.
	Schedule 2 to the Children Act 1989 requires local authorities to keep registers of sight-impaired children, and amendments 22 to 25 would only duplicate that. We have committed to explicitly reinforcing this duty in the forthcoming code of practice for children and young people with special educational needs or disabilities.
	I turn briefly to the Government amendments. Amendments 1 and 2 simply clarify the scope of the regulation-making powers as set out in the other place by Lord Howe, the Under-Secretary with responsibility for quality. They ensure that regulations can specify where local authorities do have the power to be more generous and contribute to the costs of an adult with resources above the financial limit, as well as where they do not.
	Amendment 3 allows regulations to specify where certain costs do not have to form part of the personal budget and thus do not count towards the cap on care costs. It has always been the intention that some provision, such as reablement, should be a universal, free service and therefore should not be incorporated in the personal budget. Such exemptions will not apply to general care and support that a local authority can charge for.
	Amendments 4 and 5 correct small drafting omissions in clause 34. Amendment 6 will enable us to make provision in the regulations for the appeals system for the investigation of the appeals body itself—for example, regarding allegations of maladministration. Amendment 14 sets out that, as per usual practice, we will use affirmative regulations if we need to amend primary legislation as part of the appeals regulations.
	Finally, on amendment 7, the feedback from local authorities is that it would make sense for them to have flexibility to be able to delegate functions relating to direct payments if they so wish. We agree and have accordingly tabled an amendment to remove the prohibition related to that.

Paul Burstow: I give notice that I would like to press new clause 9 to a vote and beg leave to withdraw new clause 1.
	Clause, by leave, withdrawn.
	Proceedings interrupted (Programme Order, this day).
	The Deputy Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

New Clause 9
	 — 
	Reporting on the funding for new costs arising from the Care Act

‘(1) The Joint Care and Support Reform Programme Board must inform the Secretary of State by an annual written report that it is satisfied whether sufficient funding is in place to ensure that social care is adequately funded and that the provisions in the Act can be implemented satisfactorily.
	(2) In subsection (1), the “Joint Care and Support Reform Programme Board” means the board of that name consisting of representatives of (but not limited to): the Local Government Association, the Association of Directors of Adult Social Services and the Department of Health.
	(3) The report mentioned in subsection (1) should include a statement of the satisfaction of the Joint Care and Support Reform Programme Board with (but not limited to)—
	(a) adequacy of the funding of the provisions in this Act,
	(b) on-going costs of implementation,
	(c) an additional five yearly review of the short and medium term cost of setting the eligibility criteria at the level set out in regulations.’.—(Paul Burstow.)
	Brought up.
	Question put, That the clause be added to the Bill.
	The House divided:
	Ayes 13, Noes 276.

Question accordingly negatived.

New Clause 11
	 — 
	Provision of certain care and support services to be public function

‘(1) A person (“P”) who provides regulated social care for an individual under arrangements made with P by a public authority, or paid for by a public authority, is to be taken for the purposes of subsection (3)(b) of section 6 of the Human Rights Act 1998 (acts of public authorities) to be exercising a function of a public nature in doing so.
	(2) This section applies to persons providing services regulated by the Care Quality Commission.
	(3) In this section “social care” has the same meaning as in the Health and Social Care Act 2008.’.—(Liz Kendall.)
	Brought up.
	Question put, That the clause be added to the Bill.
	The House divided:
	Ayes 208, Noes 280.

Question accordingly negatived.

New Clause 19
	 — 
	Promoting health of carers

‘(1) In exercising their functions health bodies shall—
	(a) promote and safeguard the health and well-being of carers;
	(b) ensure that effective procedures exist to identify patients who are or are about to become carers;
	(c) ensure that appropriate systems exist to ensure that carers receive appropriate information and advice; and
	(d) ensure that systems are in place to ensure that the relevant general medical services are rendered to their patients who are carers.’.—(Liz Kendall.)
	Brought up.
	Question put, That the clause be added to the Bill.
	The House divided:
	Ayes 212, Noes 269.

Question accordingly negatived.

Clause 17
	 — 
	Assessment of financial resources

Amendments made: 1,page16,line40, leave out ‘will not’ and insert
	‘is not permitted to, or may (but need not),’.
	Amendment 2,page17,line4, leave out ‘will not’ and insert
	‘is not permitted to, or may (but need not),’.—
	(Norman Lamb.)

Clause 26
	 — 
	Personal budget

Amendment made: 3,page25,line5, at end insert—
	‘(4) Regulations may make provision for excluding costs to a local authority from a personal budget if the costs are incurred in meeting needs for which the authority—
	(a) does not make a charge, or
	(b) is not permitted to make a charge.’.—(Norman Lamb.)

Clause 34
	 — 
	Deferred payment agreements and loans

Amendments made: 4,page31,line5, after ‘amount’ insert ‘or loan’.
	Amendment 5,page31,line7, after ‘amount’ insert ‘or loan’.—(Norman Lamb.)

Clause 72
	 — 
	Part 1 appeals

Amendment made: 6,page64,line31, at end insert—
	‘(k) investigations into things done or not done by a person or body with power to consider an appeal.’.—(Norman Lamb.)

Clause 78
	 — 
	Delegation of local authority functions

Amendment made: 7,page70,line27, leave out paragraph (d).—(Norman Lamb.)

New Clause 8
	 — 
	CQC thematic review of local authority commissioning practices

‘(1) The Secretary of State shall require the Care Quality Commission to conduct a special review and investigation under section 48 of the Health and Social Care Act 2008 into the impact of local authority commissioning and procurement practices on the quality and sustainability of adult social care.
	(2) The review shall examine the—
	(a) implementation and operation of sector-led improvement;
	(b) transparency of decision-making in determining rates for care and support services including the setting of arbitrary ceilings on the amounts local authorities will pay for care and support services and the use of time and task-orientated contract specifications;
	(c) impact of procurement action on the diversity and quality of care and support services;
	(d) transparency and fitness for purpose of resource allocation and similar methodologies for determining the level of personal budgets and direct payments;
	(e) type and quality of engagement by local authorities with provider organisations, service users and carers, prior to procurement action; and
	(f) ability of provider organisations to meet their statutory obligations, in particular paying employees at or above the national minimum wage.
	(3) The review will report and make recommendations to the Secretary of State within twelve months of Commencement of Part 1 of this Act.’.—(Paul Burstow.)
	Brought up, and read the First time.

Paul Burstow: I beg to move, That the clause be read a Second time.

Lindsay Hoyle: With this it will be convenient to discuss the following:
	New clause 10—Exercise of functions—
	‘When exercising functions under section 31 (Urgent procedure for suspension, variation etc.) of the Health and Social Care Act 2008, the Care Quality Commission may not take account of its functions under section 83 (Trust special administration: appointment of administrator) of this Act.’.
	New clause 12—CQC duty to support integration of social and health care—
	‘In exercising the functions and duties set out in section 90 (Performance ratings), the Commission must act always to require, enable and encourage the provision of health services in ways that support and facilitate the functions and duties of—
	(a) local authorities set out in section 3 (Promoting integration of care and support with health services etc.) of this Act,
	(b) the NHS Commissioning Board set out in section 23(1) 13N (The NHS Commissioning Board: further provision) of the Health and Social Care Act 2012, and
	(c) clinical commissioning groups set out in section 26 (14Z1) (Clinical commissioning groups: general duties etc.) of the Health and Social Care Act 2012
	where it considers that this—
	(i) improve the quality of those services (including the outcomes that are achieved from their provision),
	(ii) reduce inequalities between persons with respect to their ability to access those services, or
	(iii) reduce inequalities between persons with respect to the outcomes achieved for them by the provision of those services.’.
	New clause 27—Corporate responsibility for neglect—
	‘(1) This section applies where a person registered under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (a “registered care provider”) in respect of the carrying on of a regulated activity (within the meaning of that Part) has reasonable cause to suspect that an adult in their care is experiencing, or at risk of, abuse and neglect.
	(2) The registered care provider must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case and, if so, what and by whom.
	(3) Where abuse or neglect is suspected, the registered care provider is responsible for informing the Safeguarding Adults Board in its area and commits an offence if (without reasonable cause) it fails to do so.
	(4) A registered care provider is guilty of an offence if the way in which its activities are managed or organised by its board or senior management neglects, or is a substantial element in, the existence and or possibility of abuse or neglect occurring.
	(5) A person guilty of an offence under this section is liable on conviction to imprisonment for a term not exceeding two years, or to a fine, the range of which will be specified by regulations, or to both.’.
	New clause 28—Review of protections for persons in the health and social care sector making disclosures in the public interest—
	‘(1) Within six months of this Act receiving Royal Assent, the Secretary of State must make arrangements for an independent review of—
	(a) the adequacy and effectiveness of provisions for the protection of persons employed within the health and social care sector who make disclosures in the public interest (whistleblowers) about matters of concern to their employer, a prescribed person or body or another person or body;
	(b) the treatment and experience of past whistleblowers; and
	(c) the need and opportunities to improve existing protections.
	(2) The review shall take account of—
	(a) the efficacy of existing legal provisions, policies, procedures and practices for the protection of whistleblowing and whistleblowers and access to redress for whistleblowers who suffer adversely consequent upon their disclosures;
	(b) the available evidence on—
	(i) the impact of whistleblowing on changes in health and social care standards; and
	(ii) the treatment of whistleblowers over the last 20 years; and
	(c) other matters as required by the Secretary of State.
	(3) The Secretary of State shall arrange for a report with recommendations (or an interim report as may be required) from this review to be prepared and laid before each House of Parliament within 12 months of the review commencing.’.
	New clause 29—Duty to minimise harm—
	‘In section 20 of the Health and Social Care Act 2008 (regulation of regulated activities), after subsection (2)(b) insert—
	(c) ensuring that the likelihood of harm befalling persons in respect of whom a regulated activity is taking place is reduced as far as possible.”.’.
	New clause 30—Mandatory incident reporting and patient safety management systems—
	‘In section 20 of the Health and Social Care Act 2008 (regulation of regulated activities), after subsection (3)(k) insert—
	(l) impose requirements as to the reporting by all providers of regulated activities to the affected persons or their representative and family of incidents occurring in the carrying out of such activities which lead to the—
	(i) death;
	(ii) unexpected deterioration of condition; and
	(iii) introduction of a new adverse condition in respect of the person, regardless of the severity of the new condition and the short and long term impact on the person;
	(m) impose a requirement for the preparation and publication by all providers of regulated services of a safety management system plan.”.’.
	New clause 33—Candour Commissioner—
	‘(1) The Secretary of State shall establish an Office of the Care Commissioner for Candour and Disclosures in the Public Interest (the “Candour Commissioner’s Office”).
	(2) The Candour Commissioner shall have duties to—
	(a) protect and promote a culture of candour and disclosure in the public interest in the health and care services sector,
	(b) provide or arrange confidential advice and support for persons working in the health and social care sector considering making a disclosure in the public interest,
	(c) provide or arrange advice and support for persons in the sector who have made such a disclosure, and
	(d) monitor the treatment, employment and re-employment of persons mentioned in paragraph (c) within the sector.
	(3) The Commissioner shall report to the Secretary of State, with recommendations—
	(a) on any issue within the Commissioner’s remit as she/he sees fit,
	(b) making an assessment of the extent to which persons and bodies within the sector are protecting and promoting a culture of candour, with particular reference to the treatment, employment and re-employment within the sector of persons who have previously made a disclosure in the public interest.
	(4) The Secretary of State shall lay a copy of the Commissioner’s annual report before each House of Parliament accompanied by an explanatory statement setting out the steps that the Government plan to take to remediate any shortcomings identified by the Commissioner.’.
	Amendment 19,in clause 90, page81,line27, at end insert—
	‘(2A) The Commission must, in respect of such English local authorities as may be prescribed—
	(a) conduct reviews of the provision of such adult social services provided or commissioned by the authorities as may be prescribed;
	(b) assess the performance of the authorities following each such review; and
	(c) publish a report of its assessment.
	(2B) Regulations under subsection (2A) may prescribe—
	(a) all adult social services of a particular description; and
	(b) all local authorities or particular local authorities.’.

Paul Burstow: This part of the Bill and this group of new clauses and amendments are all about ensuring that the system delivers the best possible quality of care and that, when things go wrong, it is clear how the situation is to be corrected and what penalties will be faced by those who have let people down and, in some cases, treated them in an appalling way. There is much in this part of the Bill that is to be applauded, although the nature of the Report stage of a Bill means that we often do not applaud a Bill much, because we are focusing on the things that we want to amend further.
	New clause 8 deals with a subject that was also a feature of our discussions in Committee—namely, the concern that the commissioning role of too many local authorities, and the discharge of their responsibilities for planning for the care and support needs in their communities, had degenerated into little more than crude procurements and, worse still, in some cases just spot purchasing of care services. In some local authorities, there was no sense of strategy or of engagement with the local population, and there were no pragmatic conversations with provider organisations ahead of a procurement process. There was no real sense of how to shape the market to deliver the best possible outcome from the point of view of the wider public interest.
	Those concerns were expressed a number of times in Committee, and they have been echoed throughout all the stages of the Bill. They were certainly strongly expressed by a number of the representative bodies of
	provider organisations when they gave evidence to the Joint Committee scrutinising the Bill. Of all the evidence sessions in that Joint Committee, the one that sticks with me is the one at which the provider organisations gave evidence. There was a palpable sense of the deterioration, and even the collapse, of relationships between local authorities and providers as a consequence of the commissioning not being done well in some organisations.
	My new clause is designed to address a concern expressed by a number of organisations about a change that the Government made to the Bill in the other place. In that change, they removed from the legislation that established the Care Quality Commission the provision for periodic reviews of the performance of local authorities in regard to their statutory duties on care and support. I am prepared to accept the arguments that the Minister made before removing that provision, but only if we can have much greater certainty that the Care Quality Commission will undertake regular thematic reviews of care and support services.
	New clause 8 sets out a number of the things that I think such a thematic review should include. For example, we have established a regime for sector-led improvement whereby local authorities can seek peer review of their delivery of quality commissioning of care and support services. It is working well in some places, but there is certainly evidence that it is not in others. There is a concern that arrangements will be made that allow an inadequate level of peer review and, frankly, people to get away with not doing the right thing. That is why a back-stop provision allowing thematic reviews is absolutely essential, and why ideally I would like the CQC to be independent in its judgment on that, rather than beholden to Ministers to authorise it. That is not the situation we are in, but the new clause would have us look at those issues.
	I was told by a provider that I met at an event which the United Kingdom Homecare Association organised with me that CQC inspectors positively discourage comments about local authority commissioning. If a provider has a concern about how they are being constricted, arguably inappropriately, by a commissioner’s decision or practice and tries to raise that with an inspector, they are told, “That is not a matter for us.” It is absolutely a matter for the CQC. I hope the Minister can say something about what he will say to the CQC on that issue. It seems to me that understanding the intervention of commissioners is a really important part of gathering intelligence about the robustness of a local care economy, and the best way to gather that intelligence, at least in part, is by inspectors being open to being told about that.

Stephen Dorrell: Does my right hon. Friend agree that it is a matter of not only looking at how competently a local authority commissioning process is commissioning the service as we know it, but thinking beyond that and enlarging the role of commissioning in changing the balance in the system of care delivery?

Paul Burstow: Absolutely. That is why the duty on market shaping set out in the Bill is about stretching the local authority to take that wider population-level interest, and not only for the people for whom they will arrange care and for whose care and support needs they will pay,
	but for the whole population who might need care and support but will be funding it themselves. I do not see how local authorities can satisfactorily discharge that new and important responsibility if there is not also a fairly critical examination of commissioning practices themselves. That is why I have tabled the new clause.

Andrew George: My right hon. Friend is making an excellent case. There is another reason why it is essential that inspection in that area becomes paramount, and that is because of the drivers in the system itself that discourage avoidable hospital and community hospital admissions and seek the earliest possible discharge into the community. What we have is a scenario in which people are being cared for in their homes, in an “out of sight, out of mind” environment, so inspections become all the more important because of the need to ensure that they are safe—

Lindsay Hoyle: Order. Paul Burstow.

Paul Burstow: My hon. Friend makes an important point—

Lindsay Hoyle: I think he made a speech.

Paul Burstow: I defer to you on that point, Mr Deputy Speaker.
	New clause 8 would ensure first, that there is an examination of how sector-led improvement is working; secondly, that the concern about rates for care, which we touched on when we debated new clause 15, is looked at, particularly time and task commissioning and procurement; and thirdly, that the way in which resource allocation formula are drafted and how they operate—an issue that came up in my Committee’s inquiry into the Bill—and the fact that they are often very opaque to the public, with regard to what is and is not in them when it comes to determining the level of a personal budget, are absolutely crucial to the quality of the care someone might be able to receive.
	New clause 10 deals with an interesting unintended consequence of some of the changes the Government have made to this part of the Bill. The new clause is intended to bring some clarity to the process whereby the CQC decides that there is an urgent requirement to take regulatory action to protect the safety of patients. The powers it has in that respect are set out in the Health and Social Care Act 2008. The new clause is needed because the Bill establishes a parallel enforcement regime for NHS trusts and foundation trusts, under which the CQC has the power to make a recommendation to the NHS Trust Development Authority or Monitor that a trust be placed in special administration. The CQC therefore has two enforcement regimes at its disposal: first, the one set out in the 2008 Act, which allows it to take enforcement action; and secondly, the one that the Care Bill introduces, which will allow it to request another organisation to take enforcement action instead.
	I made a number of points in Committee about the attempt to use the special administration regime on quality grounds. I made three simple arguments. First, special administration is not a particularly suitable process for addressing quality failures, and I suspect that it will
	never be used in that way in practice. Secondly, on a related point, the triggers for using the special administration regime on quality grounds are not clear, which introduces an element of uncertainty into the regulatory process. I think that a lack of clarity and consistency in enforcement powers is a hallmark of an ineffective regulation system in the first place. Thirdly, special administration is intended to be used in the Care Bill only for NHS-owned organisations, which introduces a rather odd asymmetry in regulatory powers, which is not underpinned by any evidence that I have seen in arguing for the change.
	Whatever the merits of those arguments, however, I believe that the Minister needs to address the extra layer of complexity that is being added to the enforcement regime through the Bill. Where once the CQC alone could take action to address quality failures, now the CQC, Monitor or the NHS Trust Development Authority can take action on NHS organisations. I think that that complexity, which was a cause of concern in the Francis review, needs to be addressed further. I hope that the Minister will be able to address that.
	The purpose of new clause 10 is simple: to ensure that in the most serious cases of failure, when the CQC believes that there is a risk to patient safety, it can, should and must ignore all the added complexity created by the measure in the Bill and default to its powers to protect patients as set out in the 2008 Act. I hope that the Minister will be able to confirm that there is a clear order of precedence for how the regulator should act.
	Finally, new clause 12 deals with the CQC and integration. It simply seeks to do something that we did not do in the Health and Social Care Act 2012. That Act, largely because of colleagues on the Government Benches and concerns from the Health Committee and others, has built into it duties on every part of the system to integrate wherever possible, with health and wellbeing boards, clinical commissioning groups, NHS England, the National Institute for Health and Clinical Excellence and so on—it is hard-wired into the system. However, because the Bill we were taking through Parliament in 2011 was not really focused on the role of the CQC, we did not add that clarity of purpose on integration into its DNA. I think that is something the CQC wants to do. I know that the Minister has been sympathetic to that in the discussions we had in Committee. This is simply about saying that it is not good enough for a regulator simply to regulate institutions in the interests of patients. The interests of patients are the journeys they have through the system and the quality and experience of the care they receive. That is better defined by the way in which different organisations that they will rely on for that care are collaborating and working together. Therefore, we need to see the creation of more measures along those lines.
	I could elaborate further on these points, but I am conscious of the time. I hope that the Minister will be able to give us some further words of reassurance, not least about the discussion that I think he has had with the chair of the CQC since our deliberations in Committee.

Jamie Reed: I thank the right hon. Member for Sutton and Cheam (Paul Burstow) for getting this extensive group of new clauses and amendments under way. I understand that he shares a lot of the concerns felt by Labour Members, and the concerns of the Chair of the Health Committee have also been
	illustrated, as have those of other Government Members. It is essential that the Government take action to address the issues before the House.
	The main issue I wish to raise this evening is the ability of the Care Quality Commission to inspect the commissioning of adult care services by local authorities. A number of new clauses and amendments have been tabled, and rather than examine each in extensive detail, it will be better for colleagues if I speak to the principles at the heart of the issue. It is, however, crucial that we understand the background to this group of new clauses and amendments.
	In 2010, the Government announced the cessation of annual performance assessments. On application that has resulted in the CQC no longer inspecting the commissioning practices of local authorities. One consequences of that has been for local authorities to peer review voluntarily the services provided by neighbouring local authorities, and that in turn has resulted in the creation of a kind of opacity, or a climate of perverse incentives. Local authorities are more likely to give a neighbouring authority the benefit of the doubt on such issues. Co-operation has become the default in the sector, and although that should be welcomed to a degree, there is a disincentive for any local authority to raise issues of poor care in an adjoining local authority on which it might rely for assistance and other services. Given the financial strain on local authorities as austerity bites, they are forced to merge functions—and more—with each other, meaning that the disincentive is likely to persist for the time being at least.
	As was pointed out and discussed in some detail in Committee, a strong effective regulator is as essential in the health and social care system as in any other sector—perhaps even more so. Only through thorough and effective monitoring and enforcement can patients have confidence in the services they receive, or exercise an informed choice when choosing those services. That is why the previous Government legislated for the creation of the first ever independent regulation of the NHS, and what is today the Care Quality Commission.
	Regulatory oversight is an iterative process that by its very nature tends to be more active in taking remedial action than preventive action. It is the responsibility of every Member of the House to ensure that the regulator is given the tools and resources it requires to be as proactive as possible in preventing problems not just in the future following care failures, but before any failures occur in the first place. In short, the best regulatory systems are intelligent and proactive. That is why it is essential that the Care Quality Commission should be allowed proactively to inspect and review the commissioning of adult social care undertaken by local authorities. It is one thing to inspect the service provided—clearly that is important—but more information could be revealed, and better regulation resulting in better services would be enabled, if the regulator could inspect the process of service commissioning.
	When a service fails, we need to understand the root causes of such a failure. How has a poor service come to pass? Is it down to a poor operator, a poor service provider, or is the local authority not commissioning the right service in the right way? Under the Bill, only once a pattern of poor care is identified can the CQC apply to the Secretary of State for permission to undertake a special review. There are a number of issues with that.
	First, the quality of care would have to be extremely low for a consistent period to allow a pattern of poor care to be identified, and that does not provide the best level of protection for service users suffering from inadequate care services. Secondly, the CQC would have to bear a significant burden to prove such a pattern before undertaking a special review. Such a burden will consume time and resource, while again prolonging the time during which service users may be receiving inadequate levels of care.
	When the Minister responds, will he outline what threshold of proof would be required for a Secretary of State to grant the CQC permission for such a review, and say whether that has been modelled within the Department at any stage? Surely such issues have been considered. What mitigation does the Bill contain to prevent poor levels of care from continuing to be provided while investigations into care standards are ongoing? How does the proposed model fit the Ofsted model? On the face of it, it does not appear to fit it at all, because Ofsted does not wait for schools to fail before stepping in. I think—the Minister knows my views on this—that such a comparison has never been accurate and that strained and unnatural is a more precise description. The whole House will appreciate hearing the defence of a regulatory system that regulates only once failure has occurred.
	As the Bill stands, it would appear that current provisions are best suited for remedial action to address instances of failure. The Bill addresses only actions to be taken following poor care, but does not give the necessary freedom to the CQC to act to prevent poor care from occurring in the first instance. That puts a limit on the practices of the CQC, and on application would mean that the inspection of commissioning would take place only in special circumstances. My fear is that we are knowingly legislating for a leaden-footed regulatory regime—hence the need for amendment 19.
	The roots of care failures could be lodged firmly in the process of commissioning, and it is right that an independent regulator has the ability and duty to inspect all issues relating to the quality of provision before failures occur. Amendment 19 seeks to address the Government’s clear oversight in that regard. It would give the CQC more freedom to explore all aspects of care provision, rather than just quality, at the point where care is administered, and it would provide the scope for whole-system inspection. Problems can manifest much earlier in the process of care provision than the point at which care is received, and as such those problems must be dealt with earlier. The only way that is possible is for the CQC to be able to assess the quality of local authority commissioning.
	If the Government seek to oppose amendment 19, I would be grateful if the Minister would explain why he thinks that the rather fudged clause in the Bill should remain unamended. The commissioning of services is clearly linked to the quality of service provided, so to limit CQC oversight to just one aspect, as in the Bill, is a flawed approach that knowingly turns a blind eye to other parts of the system, which are ultimately responsible for the standard of care provided.
	The consequence of refusing to address the issues surrounding commissioning clearly results in the problems illustrated earlier by my hon. Friend the Member for Leicester West (Liz Kendall). A lack of oversight has meant that 15-minute visits and zero-hours contracts
	are quickly becoming the default option for care, rather than being used in extreme circumstances—we must all surely hear complaints about the consequences and effects of such an approach in our surgeries; I certainly do so.
	Amendment 19 would give the CQC oversight of commissioning practices and lead to an improvement in care, and new clause 8 would put a duty on the CQC to undertake a review into commissioning practices within a year of the commencement of part 1 of the proposed Act. While that would be worth while in the short to medium term, to be useful in the longer term the CQC must be able to repeat inspections when it deems appropriate, not just when the Secretary of State requires it.
	Clause 89 is entitled:
	“Independence of the Care Quality Commission”.
	Everyone across the House agrees with that principle except, it would appear, the Government in relation to this part of the Bill. Rather than giving the CQC independence to inspect commissioning services routinely, they are placing a shackle of ministerial approval on inspections that the CQC may deem necessary. That cannot be right, and to my mind it contradicts everything that the Government have said over the past 12 months regarding the need for CQC independence.
	New clause 27 is tabled in the name of my hon. Friend the Member for Blaenau Gwent (Nick Smith). It would create an offence of corporate responsibility for neglect, which could see directors of care providers face jail if their management of a service led to abuse or neglect. I pay tribute to my hon. Friend’s work on this issue, and I know he works tirelessly helping those who have suffered as a result of neglect in the adult social care system. He does superb work in the House and is a credit to his constituency and his illustrious predecessors. It is right that we do everything in our power to ensure that those who abuse or neglect people in care are held to account. We put an inordinate amount of trust and faith in care providers, and if that trust is betrayed by wilful neglect or mismanagement, the perpetrators should face real punishment. These services are provided for some of the most vulnerable people in our society, and harm brought about by neglect must be punished. I would be grateful if the Minister would speak more about those issues, and say how the Government intend to address them.

Charlotte Leslie: I shall speak to new clauses 28, 29, 30 and 33, which stand in my name and those of other hon. Members from both sides of the House.
	There is a huge amount to welcome in the Bill, and on Second Reading I welcomed the steps in part 2 to implement many of the recommendations in the Francis report. I said at the time that although there has been good progress, there remains a lot more to do, which is the reason behind the new clauses. I have tabled four new clauses—two on whistleblowing and two on patient safety. Those are both vital areas that we must get right.
	I welcome the measures that the Government have taken to improve protection for whistleblowers, including changes to the Public Interest Disclosure Act 1998 and the banning of gagging clauses. Whistleblowers are not only individuals who are able to see where things have
	gone wrong when others around them have perhaps gone native and begun to accept the unacceptable, but they are people with the moral backbone and courage to speak out when things are wrong. It is hugely important that we have a culture where people do not need to become whistleblowers, because their complaints are taken up far earlier and they do not need to go down routes outside the usual complaints process. We should have a culture where people are encouraged to speak out, and where raising concerns is seen as a good thing.
	As I have said, there are still far too many whistleblower cases and there is a lot more to do. That is illustrated by the fact that the Secretary of State had to step in last week to intervene in a whistleblower case. The Select Committee on Health was told that the chief executive of NHS England, Sir David Nicholson, will personally intervene in such cases to champion whistleblowers. It is interesting that Sir David is revelling is imminent freedom to mock the Secretary of State and some of his NHS England colleagues when he does not seem to have been that proactive in stepping in to champion whistleblowers previously. I very much hope that his successor proves more effective on that front, but I digress.
	There is an awful lot more to do. The key thing about new clause 28 is that it would introduce a report on whistleblowing. That would provide an audit of how the Government’s recommendations and new policy affects things on the ground, which would be welcome to the Government, whistleblowers and hospitals in general. It would also provide a valuable arena in which historical whistleblowing cases can be looked at. That would provide a kind of truth and reconciliation process for many who have not seen justice, including victims of bad care and their families, and whistleblowers who have tried to highlight cases. Crucially, we could look at how those whistleblowers were treated and where they are now. Far too many do not go on to be gainfully employed, but they should be the first people to be employed in their sector—I will say more on that in a moment. We can also look at whether their concerns have been taken up and whether anything has changed. One of the most common complaints is that nothing changes after whistleblower cases, when people have risked their livelihood to speak up against something and try to change things. The proposal would provide an opportunity to look at why those changes are never made and what we can do about it. The report could make recommendations to the Secretary of State on how to ameliorate that.
	New clause 33 deals with what happens to whistleblowers and the role of candour. It would introduce a candour commissioner for health and social care to report annually on the culture, which is so damaging to our NHS, whereby problems are hidden as opposed to being brought out into the disinfectant of sunshine. The annual review would give confidence to whistleblowers that someone independent takes them seriously. The measure might begin to deal with the toxic problem of whistleblowers being effectively surreptitiously blacklisted because they are not re-employed in their sector.
	One amendment I wanted to table—it was outside the scope of the Bill—would have meant that, instead of a blacklist, there would be a white list of whistleblowers.
	If a whistleblower’s complaint were vindicated, a white flag would go up next to their name. Any employer within the sector who did not give the whistleblower a job would have to say why they are not the right person for the job. I was hoping that such an amendment would go some way to working against the unofficial blacklist that so many of our brave whistleblowers face.
	My other proposals are on patient safety. New clause 29 is on zero harm. We have learned, tragically, in the past few months of things that happened over the past decade. We would not have expected to have to put minimum requirements of care in law, but they should have been put down in law, because, sadly, on too many occasions, those basic standards and requirements of humanity were breached. New clause 29 would put zero harm—the Hippocratic oath—into law to ensure that they are not breached.
	New clause 30 would introduce mandatory incident reporting and patient safety management systems. It would permit the Government to introduce regulations to ensure that all health care providers tell the patient or their family during a patient’s care when death, deterioration of condition or the introduction of a new condition occurs. That is not necessarily for blame, but simply for information. The worst thing is that when mistakes happen—they will; that is natural in something as difficult as health care—families are not told. That is damaging to our NHS. If mistakes happen, families must be told. Even if a deterioration occurs and is not a mistake but a natural course of events, the family should be told clearly what has occurred. The new clause would place a requirement on all providers to publish a patient safety management system, which many good providers do, to describe clearly their procedures for ensuring that patients are kept safe. Good providers already do that, but it should be a minimum requirement for all providers.
	Those would be valuable added safeguards to clause 80. As we have seen, with the best of intentions and optimism, minimum humane standards have not been met. I believe that the proposals should be included in the Bill to provide a facility by which those who do not abide by such minimum care standard are held to account.

Nick Smith: New clause 27 would establish an offence of corporate neglect. The problem needs to be tackled following police Operation Jasmine in south-east Wales. That six-year investigation of care-home abuse cost £11.6 million. Three care workers were prosecuted, but the owners—in my view, they were real culprits—escaped punishment owing to legal hurdles. That is not acceptable. One patient had appalling sores. They were so infected that the bone underneath was visible. I was deeply shocked at the photographs of neglect I was shown from the case. The then deputy chief constable of Gwent police said:
	“There is a likelihood that there are cases like this occurring every day…across the country”.
	New clause 27 would ensure that care providers are in no doubt that their primary responsibility is the care of their residents. It is supported by Age UK and was recommended by the Joint Committee on the draft Care and Support Bill, which conducted pre-legislative scrutiny.
	I accept that the Government’s proposals to strengthen the Care Quality Commission will go a significant way to preventing horrific abuses such as those at Winterbourne
	View, but without the offence of corporate neglect, the proposals do not do enough. In the Winterbourne View case, the longest sentence for a staff member—they pleaded guilty to nine charges of ill treating patients—was two years. That sentence is mirrored in other cases. It is only fair that an equal sentence is available in cases of corporate neglect.

Tom Clarke: I have listened with great interest to my hon. Friend, as I did to the hon. Member for Bristol North West (Charlotte Leslie). Given that many such awful incidents involve people with learning disabilities, will he assure me that he has very much in mind their views as well as those of their advocates and families, and that they will be embraced by the legislation, particularly if his proposals are agreed to?

Nick Smith: I assure my right hon. Friend that the new clause refers to all adults, so takes on board the people he mentions.
	Subsection (4) of the new clause seeks to strengthen protection. It would ensure that, if abuse were found to have an element of corporate responsibility, and if systems or the approaches taken by the care provider are a contributory factor in the abuse or neglect, the new offence would allow the prosecution of a registered care provider. The Government have the opportunity to shape the culture of the care sector in the Bill tonight.

Grahame Morris: In Committee, the Minister said that he supported the sentiment of the proposal. Does my hon. Friend accept that, although the new fit and proper person test and the new fundamental standards are important, they do not make provision for a custodial sentence for proprietors, managers and directors of such establishments in such cases?

Nick Smith: My hon. Friend has got to the nub of the issue. Managers and directors of organisations such as care homes have to accept that they set the culture of those places, and that they are responsible for looking after the residents in their care, and for avoiding neglect and abuse. If they get it wrong, they should face the possibility of a jail sentence. That is what the new clause would do.
	We must go that extra mile to ensure that our safeguards deliver for care home residents. New clause 27 would greatly help that cause and. I intend to divide the House on the measure.

Stephen Dorrell: I want to speak primarily to the new clauses moved by my right hon. Friend the Member for Richmond, but first I wish to comment on the speech by my hon. Friend the Member for Bristol North West (Charlotte Leslie), who has been a consistent advocate of the importance of ensuring that we have a culture in our health and care system that creates space for whistle- blowers, not because we want a world full of whistleblowers, but because we want an open culture—as she rightly says—in which the whistleblower is redundant.
	The example often cited in this area comes from the US Navy. A junior rating prevented flying from an aircraft carrier because he was concerned about a safety element. As it happened, the concern was misplaced, but the rating was celebrated because he had the courage
	to raise it. The culture of the ship was such that it allowed that individual to take the steps necessary to cover the risk. In a sense, the story is most telling because the concern was misplaced but the individual was celebrated for having had the courage to take action. That is the kind of culture that we should have in the health and care system.
	I do not agree that we need a candour commissioner: it is part of the core function of the Care Quality Commission’s inspections of health and care provider institutions to make an assessment of whether that culture exists in an institution. If that culture does not exist, it is hard to see how that institution can deliver the standards of care that we would all want to see.
	My main reason for speaking is to pick up the points raised by my right hon. Friend the Member for Richmond—

Paul Burstow: Sutton and Cheam.

Stephen Dorrell: Forgive me—the right part of London, but the wrong constituency.
	My right hon. Friend is on to an important point and I shall listen with care to what the Minister has to say in reply. We have been arguing for the best part of a quarter of a century about the role of commissioners, not just in the social care sector but across the health and care sector. As my right hon. Friend said, in different parts of the Health and Social Care Act 2012 this commitment to what is, in the jargon, called integration, but what I prefer to call joined-up services, is introduced into different parts of the system. Rightly, my right hon. Friend wants to include it in the terms of reference of the Care Quality Commission, but we need to think beyond just introducing it as an add-on into bits of legislation, the prime purpose of which lies elsewhere.
	In my view we have no choice—and I do not particularly want a choice—but to create a health and care system that puts more emphasis on prevention, on community services and on joining those services to the rest of the health and care provider network. For a quarter of a century we have been seeking, rather spasmodically and under Governments of all political complexions, to build a commissioner system charged with delivering that type of care system. Ministers need to rise to the challenge of showing how we move from where we are today towards a commissioning system that is fit for purpose to deliver that type of care outcome. The system that we operate is often described as fragmented, and we all know that different parts of the system are indeed fragmented. But the fragmentation is worst in the commissioning institutions. We have social service authorities that are responsible for commissioning social care, and in the next sentence of our speeches we say that that is the same thing as community services, but those are commissioned by CCGs. In the next breath, we say that community health is the same as primary health, but that is commissioned by NHS England. As they say in the modern jargon, “Talk me through it.” How do we deliver properly joined-up services if the people responsible for commissioning the service are so fragmented?

Paul Burstow: My right hon. Friend is making a very important point, which he has pursued vigorously as Chair of the Select Committee. Does he agree that
	part of the evolution that needs to take place is an extension of the role that we originally envisaged for health and wellbeing boards, so that they become the place where these matters come together? The default should be changed to one that presumes integration and joined-up services, rather than the other way around.

Stephen Dorrell: I agree with the thought that my right hon. Friend identifies. I have been choosing my words with care—I hope—in inviting the Minister to chart a course towards a more joined-up concept of commissioning. Almost as I offer my critique of the commissioning structures, I can feel officials in the Box writing the next version of the legislation that will have another go at providing the perfect solution to deliver something that is better than we have ever dreamt up before. I emphasise that what I am looking for from the Minister is a route map or journey—a process, not an event—and preferably one that builds on existing institutions rather than committing what I regard as the mistake of starting again with a clean sheet of paper.

Grahame Morris: The idea that the right hon. Gentleman propagates, which he has long held—that fragmentation is a bad thing and integration and joined-up services are a good thing—is one that I subscribe to, but does he share my concerns at reports that the commissioning functions through the clinical commissioning groups are to be privatised? Is that likely to make for more joined-up services or greater fragmentation?

Stephen Dorrell: The hon. Gentleman knows that I do not entirely share his concern about who holds the share certificate for a particular service. I am more concerned about the accountability of a public authority for the use of public money to deliver a public service. On that, the hon. Gentleman and I are probably as one. I am also concerned that the system, from the perspective of the patient and service user, does not rely on them finding their way under their own steam through an impenetrable morass, but is designed with their needs and instincts in mind. That is a test that our current system simply does not pass and has not passed for many years.

Tom Clarke: The right hon. Gentleman speaks with enormous authority on these matters. On the issue of community care, does he agree that for many years we have talked about joint planning, which is essential if community care is to be delivered? Does he feel that, even with the Bill and the proposed new clauses, the commission would have sufficient authority to ensure that it works as efficiently and sensitively as the House would expect?

Stephen Dorrell: No, I do not believe that simply empowering the Care Quality Commission to go into that space is the answer to the question that I am posing. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) is closer to the right answer in identifying the health and wellbeing board at a local level as the beginnings of an organisation that can deliver a more joined-up commissioning process, joining up the social care system, the community health system, the primary health system and, of course, the hospital service—and
	I always add the social housing people. In a properly joined-up service, they would focus their attention on the needs of the individual patient service user—an awful piece of terminology; we cannot work out precisely what to call them.
	I wish to highlight a bit of institutional tension. My right hon. Friend the Member for Sutton and Cheam proposes that this is a function for the CQC, but I am not entirely convinced. A tension underlying several contributions this evening relates to whether the CQC is the regulator of a provider, or an organisation with responsibility for charting the course, which I am looking for from the Minister, towards a new form of commissioning. The CQC has a full job to do responding to some of the things that my hon. Friend the Member for Bristol North West was talking about—culture and service quality on the provider side—and I am not persuaded that trying to manoeuvre it into the space of developing the kind of joined-up commissioning service I am describing is the right answer to that question.

Norman Lamb: I reassure my right hon. Friend that I want to chart the course with him. I completely agree on the need to bring commissioning together. The better care fund is a good nudge in the right direction, but we need to go much further in due course.

Stephen Dorrell: I am grateful to the Minister for his encouragement that I am on the right path.
	There is a serious question here. I agree with my right hon. Friend the Member for Sutton and Cheam that, at a local level, the health and wellbeing board is the organisation best placed to move forward with the process of more joined-up commissioning. How we, as MPs, satisfy ourselves that this is happening to the required standard, with the required levels of economic efficiency across the system as a whole and above the level of the health and wellbeing board, is one of the questions left unanswered by the institutions we currently have. I am not entirely persuaded that the CQC should be encouraged into what I regard as a vacuum.

Emma Lewell-Buck: I will speak to amendment 19 and echo some of the excellent comments made by my hon. Friend the Member for Copeland (Mr Reed).
	Amendment 19 would reinstate the Care Quality Commission’s duty to inspect the commissioning of adult social care services by local authorities. The case for the amendment is very simple: the quality of commissioning has a huge impact on the quality of care that people receive. It is extremely important that our adult social care system includes checks to ensure that commissioning is of a high standard. At present, this is not the case.
	The current model of sector-led improvement introduced by this Government in 2010 leaves it to local authority peer reviews to identify failure. In practice, this means that neighbouring authorities that already work in close collaboration inspect each other, but only when a neighbouring authority volunteers for inspection. Of course, local authorities that are confident in their commissioning practices are happy to volunteer themselves for scrutiny, but what about those that do not volunteer? It is surely those authorities that we should be most concerned about, yet under the current system they are not subject to proper oversight. Worryingly, the majority
	of authorities have not been assessed under the peer review scheme. In total, 127 local authorities have not had their commissioning reviewed since 2010. We would not allow this type of reckless leniency with any other service that looks after our most vulnerable. I am certain that it should not continue.
	It is clear that when it comes to inspecting local authorities’ commissioning practices, some uniformity and impartiality are needed. The CQC is best positioned to carry out that duty. Certainly, the chief executive of the CQC thinks so, commenting that he has not
	“spoken to any national provider association who doesn’t think councils should be inspected”
	and believes that
	“the removal of that power from CQC was seen as a retrograde step”.
	When this proposal was raised in Committee, the Minister insisted that it was unnecessary. He argued that CQC inspection of providers could identify patterns of poor commissioning that would be grounds for a special review.

Tom Clarke: My hon. Friend is making a convincing case. I have a background in local government. Does she agree that if statutory obligations are placed on local authorities, it is important that that they should be followed by the appropriate resources, but that that is not always the case?

Emma Lewell-Buck: I agree completely, and I will echo my right hon. Friend’s comments later in my speech.
	I have some doubts about how effective CQC inspection of providers would be in practice. It is not clear at what point the CQC would recognise that poor provision was caused by poor commissioning practices. A handful of poor examples could be just that, or it could be evidence of a more systemic problem. Given the need for the Secretary of State’s approval before a special review is undertaken, I am concerned that the threshold of proof needed will be extremely high. Furthermore, CQC inspectors will not visit all providers in a single local authority area at the same time. In practice, it could take some months before information is collated and a pattern of failure detected that might indicate sub-standard commissioning. There is also a doubt about who will be joining up the dots to link months’ worth of inspections to a local area’s commissioning practices. In short, how will anyone ever know that poor providers are linked to poor commissioning by a particular local authority? The reality is that by the time the CQC recognises that there is a case for a special review, numerous safeguarding issues could have arisen.
	I am concerned that, under the model the Minister advocated in Committee, action will be taken only once patterns of poor care have already taken root in a local authority. Surely that is the wrong way round. We need to prevent poor care arising from substandard commissioning, rather than wait for problems to become embedded in the system. This not only makes sense financially: from a safeguarding perspective, it is essential. I am concerned that without rigorous oversight, social care departments will find it easier to allow standards to slip.
	In Committee, the Minister argued that the duty for local authorities to consider well-being would incentivise good practice. I do not believe that this is enough. I do
	not want to be critical of any local authority’s will to ensure the well-being of their service users, but I know from personal experience that these departments face intense pressure. If something is not built into the system, it is less of a priority. If departments know that the CQC will not be knocking on the door this year, they will concentrate on more urgent matters—trust me, in adult social care there are always urgent matters. Knowing that they are subject to regular oversight makes departments foster a culture of good practice.
	In discussions I have had with providers and commissioners, they say they are in favour of reinstating the clause. Commissioners, whose day job is to fill gaps in services and to do so in the most cost-effective way, are worried that their decisions are not properly scrutinised, and that any mistakes they may unwittingly make will go unchallenged. Providers want it to be clear when they are at fault or when failure is down to poor commissioning. They do not want under-resourced providers to be punished simply because the rates that they receive from the local authority are too low to provide decent care.
	I remain puzzled about why, although in June last year the Minister admitted that sector-led improvement had serious shortcomings for weaker-performing councils and, presumably because of his doubts, the Bill originally included the new clause, yet in October, for some reason, it was removed on Report in the other place, and the Minister has now moved from being in favour of CQC inspection of commissioning to being against it. I was also puzzled when the Minister repeated his concern about sector-led improvement in Committee. Following an intervention from the right hon. Member for Sutton and Cheam (Paul Burstow), he said that he shared the right hon. Gentleman’s view that
	“the danger with sector-led improvement is that those bodies who are up for change and improvement take part and those who are dysfunctional and failing do not engage.” —[Official Report, Care Public Bill Committee, 28 January 2014; c. 442.]
	Given that the CQC, providers and commissioners—along with the Minister— recognise the blind spots that exist in the sector-led improvement system, I hope that the Minister is open to convincing on the issue. If he is not convinced, I hope that he will be able to explain what he could not explain in Committee, namely why he and the Government changed their minds.

Norman Lamb: Let me begin by thanking all Members for their contributions to the debate.
	Part 2 of the Bill contains a range of measures to implement the Francis recommendations following the awful events at the Mid Staffordshire NHS Foundation Trust. The changes that we are introducing are intended to make a reality of Robert Francis’s recommendation that the NHS, and indeed all care services and those who work in them, should adopt and demonstrate a shared culture in which the patient is always the priority.
	I accept the principle that lies behind new clause 8 and amendment 19, but the oversight of commissioning is not the core purpose of the CQC. I want the CQC’s main focus to be on providers and the quality of care provided for patients and service users. Any review or investigation of commissioning of services by the CQC will have an impact on its capacity to oversee service provision, and should be selected with care. It is therefore
	right for any CQC special review or investigation of commissioning to continue to be either at the request of, or subject to the approval of, Ministers—in the case of reviews of local authority commissioning, the Secretaries of State for both Health and Communities and Local Government.
	I want to make my position absolutely clear. If there is strong evidence of a link between commissioning and poor care, the CQC will be able to examine it.

Paul Burstow: rose—

Emma Lewell-Buck: rose—

Norman Lamb: I will give way to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) first.

Paul Burstow: I apologise for getting in just before the hon. Lady.
	May I return to a point that I raised in my opening remarks? At present, inspectors disavow the opportunity of providers to give them the evidence to which the Minister has referred. They say that they are not interested in it. Will the Minister ensure that the CQC and its inspectors are open and receptive to such evidence when providers offer it to them?

Norman Lamb: Subject to the fact that the CQC is an independent body, I will certainly reinforce that point in my discussions with it. In the context of mental health, we were discussing with the CQC only last week the importance of the role of commissioning as well as that of provision. I entirely accept that good care can be provided only if we get both the commissioning side and the provider side right: the two must go together.
	Is it appropriate to set out the specifics of a review of commissioning in the Bill? I do not believe that it is. Flexibility is vital. While the CQC has a power to conduct special reviews and investigations of commissioning, that must be set in the context of other measures in the Bill that will strengthen the duties that local authorities must fulfil in exercising their care and support functions.

Emma Lewell-Buck: Perhaps I am being impatient—the Minister may deal with this point later in his speech—but I should like to know who will routinely review local authority commissioning. If no one will be doing that, how will the CQC know that poor commissioning is taking place in a local authority area?

Norman Lamb: I take very seriously the point that the hon. Lady has raised, but if she will allow me to continue to present my argument, I shall be happy to return to it later if necessary.
	The important new measures include an express duty to promote people’s well-being—a duty to shape local care markets to ensure that they are sustainable and diverse, and offer high quality care and support. The Department will work with the local government and adult social care sector to produce statutory guidance on local authority commissioning of care and support. However, a CQC review of commissioning remains an option. I reassure right hon. and hon. Members that we
	will review evidence of concerns about local authorities’ commissioning practice to establish whether it is appropriate to ask the CQC to undertake a targeted review under section 48 of the Health and Social Care Act 2008. Getting the message out to commissioners that the powers will be used is important in itself to concentrate minds. They will be under the spotlight if they fail in their commissioning responsibilities.
	New clause 12 would require the CQC to consider integration of care as part of its performance assessments of registered providers of health and adult social care. In Committee, my right hon. Friend the Member for Sutton and Cheam made a strong case for the new system of performance ratings to be carried out by the CQC to look at care pathways, rather than focusing on separate institutions in isolation. He makes a very good case. I explained that a central tenet for the Government is that the independence of the CQC improves its effectiveness as a regulator. Clause 89 removes nine separate powers for the Secretary of State to intervene in the day-to-day workings of the commission, and we have deliberately removed the Secretary of State’s power to devise or approve the system for performance assessments and ratings.
	The CQC has to be responsible for the system of performance assessment that it introduces, and placing specific requirements on the commission in legislation would not help in that regard. That is not to say that the CQC should not look into the integration of care. I told the Committee that I would pursue that matter in my discussions with the CQC, and I have done so. I have spoken to the CQC chair, David Prior, and to the chief executive. I am pleased to say that in that regard we are pushing at an open door. They absolutely understand the case that my right hon. Friend makes.
	In recent weeks, the commission’s chief executive, David Behan, has set out plans for the CQC to carry out thematic inspections to look at the care pathways for different conditions. One such thematic programme will look at how people with dementia are handled by relevant services in a geographical area—acute health care, primary health care and adult social care, for example. Another is looking at how people move across transition points, such as when a disabled child becomes an adult—a point at which too often services fall down.

Tom Clarke: The Minister has outlined that he wants to work with the commission, local authorities and others in these important matters. Does he agree that there are issues on which organisations such as Mencap have a lot to contribute? Would he see the Government’s approach on those matters as being inclusive in that respect?

Norman Lamb: I totally agree with the right hon. Gentleman. The more that we talk to organisations with expertise such as Mencap when we are designing the commissioning and inspecting of facilities, the better we are at the job that we do. We must not think that we have all the answers in Whitehall.
	A future thematic review could consider the integration of health and social care services either in a particular location or across a particular condition. I am keen that the commission pursue that further, but, as I say, I think that we are pushing at an open door in that regard.
	New clause 33 would create the new post of candour commissioner for England. The commissioner would be tasked with protecting and promoting a culture of candour and disclosure in the health and social care sectors, an ambition that I think we would all share. The Government are taking steps to make a culture of candour and openness a reality. We will put in place a statutory duty of candour on providers registered with the CQC—I am personally delighted that we are doing that. That will require providers of health and social care to be open with patients and service users where there are failings in care.
	I commend to the House the excellent review of the duty of candour by Professor Norman Williams and Sir David Dalton, which was published last week. We will consider the recommendations of the review—I repeat that I thought it was excellent—as we develop regulations to implement the duty of candour as a requirement for registration with the CQC. We are also enhancing the professional duty of candour through changes to professional guidance and codes.
	Effective whistleblowing and complaints systems are vital parts of an open and transparent culture. As the Committee Chair, my right hon. Friend the Member for Charnwood (Mr Dorrell), pointed out, what we are after is a system in which whistleblowing is no longer necessary because the culture is open. That will help to improve public and patient safety and the quality of services provided.
	This Government support the right of staff working in the NHS to raise concerns and expect all NHS organisations to support staff who wish to do so. NHS organisations have to have in place policies that are compliant with whistleblowing legislation. Also, the CQC’s new inspection system will include discussions with hospitals about how they deal with whistleblowers, and the CQC is reviewing its arrangement for handling whistleblowing concerns. The CQC’s national adviser for patient safety has recently established, and chairs, a forum of whistleblowers, so the CQC understands the issue and recognises its central role in this regard.
	I am sure that my hon. Friend the Member for Bristol North West (Charlotte Leslie) will agree with me that we will only achieve the change in culture that we are seeking by creating champions for candour and openness throughout every tier of every organisation—people who really believe in openness in both health and adult social care. Promoting and protecting candour is the business of every member of staff in health and social care. Indeed, the Dalton-Williams review prefaced its discussion of the candour threshold with a clear recommendation to establish a culture of candour based on training and support of staff and more accurate reporting of safety incidents.
	I would also point out that the creation of a new office of candour commissioner would need funding. Given the measures we are already putting in place to support candour, I am not convinced that a candour commissioner would be the best use of finite resources.
	New clause 28 would require the Secretary of State to commission an independent review of whistleblowing arrangements within six months of this Bill coming into force. I recognise that reviews, as suggested in this amendment, can play a key role in ensuring that legislation is operating as intended—a form of post-legislative scrutiny. It is for this reason that the Government, through the Department for Business, Innovation and
	Skills, have recently carried out “The Whistleblowing Framework: Call for Evidence”. This call for evidence is part of a review of the effectiveness of the legislation around whistleblowing, specifically considering whether the protections available in the Public Interest Disclosure Act 1998 for those wishing to raise concerns are effective. Members of the public and experts have been asked to submit evidence to BIS’s review. The findings will be published this spring. My Department has submitted evidence to this review on behalf of the health and care sectors, having taken the views of the professional regulatory bodies, but I do not support putting a commitment in primary legislation to undertake a review such as the one suggested in the amendment.
	New clause 10 relates to the single failure regime for NHS trusts and foundation trusts. I repeat the assurance given in Committee that where the chief inspector of hospitals finds that patients are exposed to an immediate risk of harm, he will continue to be able to take swift and decisive action under section 31 of the Health and Social Care Act 2008. This new clause would prevent the CQC from being able to trigger trust special administration on quality grounds while it was using its powers under section 31. The chief inspector needs to be able to draw on the full range of the CQC’s powers to ensure regulatory action is appropriate in each case. We must not set unnecessary constraints on the CQC’s ability to address failings in quality. There may well be situations where the CQC needs urgently to suspend a particular service and also to consider trust special administration to ensure that high quality services can be sustained.
	Let me make it clear that the CQC will be able to trigger trust special administration only where there has been a serious failure of quality and it is appropriate to do so. There are a number of ways to support trusts to improve, ensuring that special administration is only the last resort. Monitor and the NHS Trust Development Authority have a range of intervention powers and can also place trusts and foundation trusts in special measures to provide a package of measures to support improvement.

Paul Burstow: The Minister mentioned that a number of measures may be taken pre-failure in order to avoid the failure regime being triggered. Before tomorrow’s debate on clause 119, will he supply the measures by way of example, so that we can debate those very issues?

Norman Lamb: I am happy to ensure that a note goes to my right hon. Friend and other Members, as he requests.
	New clauses 29 and 30 would introduce a power to create new requirements for registration with the CQC, one requiring providers to minimise the risk of harm to patients and service users, and the other requiring providers to inform patients and their representatives where treatment leads to harm, and to prepare a safety management plan. Section 20 of the Health and Social Care Act 2008 sets out the areas in which the Government may impose, through regulations, requirements on providers registered with the CQC. It is a broad power and expressly allows regulations for
	“securing the health, safety and welfare of persons”
	for whom services are provided. This is broad enough to include minimising harm to patients. In addition, it expressly includes a power for the registration requirements to cover
	“the manner in which a regulated activity is carried on”,
	which would cover a requirement to prepare a safety management plan.
	Clause 80 also places a duty on the Government to introduce a new registration requirement of informing patients and service users where there have been failings in their care—the duty of candour. I hope that I have reassured my hon. Friend the Member for Bristol North West that the power already exists to include the proposed areas in the CQC registration requirements.
	My Department is consulting on draft regulations to put in place new fundamental standards as requirements for registration with the CQC. These would require providers to take “appropriate steps” to mitigate the risks of service users receiving care that is “inappropriate or unsafe”. We plan to consult shortly on a new duty of candour requirement. We will, of course, develop the final regulations, which will be subject to the affirmative procedure, in the light of the comments received in the planned consultation.
	Finally, I support the sentiment behind new clause 27, that providers of care services should be held to account where they allow abuse or neglect, and that there should be serious consequences where this occurs. Under the fundamental standards on which we are consulting at the moment, all providers registered with the CQC must take steps to avoid abuse and neglect, and take action where those occur. Where providers are responsible for abuse, the CQC will be able to prosecute them. In fact, in response to Winterbourne View, I took the view that there was a gap in the regulatory framework, which did not allow for proper corporate accountability. I felt that we had to change the arrangements to ensure that companies, trusts and other providers were held to account where they were responsible for abuse or neglect. We are achieving that objective.
	In addition, we have brought forward proposals to respond to the most egregious failures of care. On 27 February, we published our consultation on the detailed proposals for a new criminal offence of ill-treatment or wilful neglect. The Berwick report was clear that this offence should apply to individuals and organisations, whether or not they are registered with the CQC. We agree with that approach, and are consulting on the proposal. The new criminal offence, together with the CQC’s responsibility to respond to poor quality care, is sufficient to ensure that action is taken against unacceptable standards of care, and that there are serious consequences where this occurs.

Paul Burstow: I am grateful for the Minister’s responses to my three new clauses. I look forward to hearing what other hon. Members have to say about their provisions, but on the basis of the assurances I have been given, I beg to ask leave to withdraw the clause.
	Clause, by leave, withdrawn.

New Clause 27
	 — 
	Corporate responsibility for neglect

‘(1) This section applies where a person registered under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (a “registered care provider”) in respect of the carrying on of a
	regulated activity (within the meaning of that Part) has reasonable cause to suspect that an adult in their care is experiencing, or at risk of, abuse and neglect.
	(2) The registered care provider must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case and, if so, what and by whom.
	(3) Where abuse or neglect is suspected, the registered care provider is responsible for informing the Safeguarding Adults Board in its area and commits an offence if (without reasonable cause) it fails to do so.
	(4) A registered care provider is guilty of an offence if the way in which its activities are managed or organised by its board or senior management neglects, or is a substantial element in, the existence and or possibility of abuse or neglect occurring.
	(5) A person guilty of an offence under this section is liable on conviction to imprisonment for a term not exceeding two years, or to a fine, the range of which will be specified by regulations, or to both.’.—(Nick Smith.)
	Brought up, and read the First time.
	Question put, That the clause be read a Second time.
	The House divided:
	Ayes 217, Noes 265.

Question accordingly negatived.
	Proceedings interrupted (Programme Order, this day).
	The Speaker put forthwith the Question necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

Clause 90
	 — 
	Reviews and performance assessments

Amendment proposed: 19,page81,line27, at end insert—
	‘(2A) The Commission must, in respect of such English local authorities as may be prescribed—
	(a) conduct reviews of the provision of such adult social services provided or commissioned by the authorities as may be prescribed;
	(b) assess the performance of the authorities following each such review; and
	(c) publish a report of its assessment.
	(2B) Regulations under subsection (2A) may prescribe—
	(a) all adult social services of a particular description; and
	(b) all local authorities or particular local authorities.’.—(Mr Jamie Reed.)
	Question put, That the amendment be made.
	The House divided:
	Ayes 220, Noes 282.

Question accordingly negatived.

New Clause 34
	 — 
	The Health and Social Care Information Centre: restrictions on dissemination of information

‘(1) Chapter 2 of Part 9 of the Health and Social Care Act 2012 (the Health and Social Care Information Centre) is amended as follows.
	(2) In section 253(1) (general duties), after paragraph (c) (but before the “and” after it) insert—
	“(ca) the need to respect and promote the privacy of recipients of health services and of adult social care in England,”.
	(3) In section 261 (other dissemination of information), after subsection (1) insert—
	“(1A) But the Information Centre may do so only if it considers that disseminating the information would be for the purposes of—
	(a) the provision of health care or adult social care;
	(b) the promotion of health.”.
	(4) After section 262 insert—
	“262A Publication and other dissemination: supplementary
	In exercising any function under this Act of publishing or otherwise disseminating information, the Information Centre must have regard to any advice given to it by the committee appointed by the Health Research Authority under paragraph 8(1) of Schedule 7 to the Care Act 2014 (committee to advise in connection with information dissemination etc).”’.—(Dr Poulter.)
	Brought up, and read the First time.

Daniel Poulter: I beg to move, That the clause be read a Second time.

Mr Speaker: With this it will be convenient to discuss the following:
	Amendment (a) to Government new clause 34, in subsection (3), after ‘of’, insert ‘improving’.
	Amendment (b) to Government new clause 34, in subsection (3), after ‘adult social care’, insert
	‘; and if it has satisfied itself that the recipient is competent to handle the data in compliance with all statutory duties and to respect and promote the privacy of recipients of health services and adult social care.”.’.
	New clause 25—Misuse of data provided by the Health and Social Care Information Centre: offence—
	‘(1) A person or entity commits an offence if they misuse, or negligently allow the misuse of information they have requested and received from the Health and Social Care Information Centre.
	(2) “Misuse” means—
	(a) using information in a way that violates the agreement with the Health and Social Care Information Centre;
	(b) using information in a way that does not violate the agreement with the Health and Social Care Information Centre, but that gives rise to use that is outside the agreed limits of use; or
	(c) using information supplied by the Health and Social Care Information Centre in such a way as to allow or enable individual patients to be identified by a third party.
	(3) A person who is guilty of an offence under subsection (1) is liable—
	(a) on summary conviction, to an unlimited fine;
	(b) on conviction on indictment, to imprisonment for not more than two years or a fine, or both.
	(4) An entity who is guilty of an offence under subsection (1)—
	(a) is liable to an unlimited fine; and
	(b) must disclose the conviction on all future applications to access data from the Health and Social Care Information Centre.’.
	Government amendment 8.
	Amendment 29, in clause 116, page100,line29, after ‘Authority’, insert
	‘and the Secretary of State’.
	Government amendments 17, 18, 15 and 16.

Daniel Poulter: The Government are fully committed to the care.data programme and to the core principles that underpin its use, which are to present and promote transparency in the quality of health and care services to patients and the public, while protecting their privacy and confidentiality; to promote health and care research to help us to understand how to fight disease, cure illness and improve care; and to better integrate health and care services by using the data and information to understand what good, joined-up and integrated care looks like.
	The data that are collected across the health and care system in England are the envy of the world. The care.data programme, which draws on the new Health and Social Care Information Centre, offers the ability to link existing data securely and safely to produce information that can save lives, quickly find new treatments and cures, and support research to benefit us all.
	I want to say at the outset that, in my view, the care.data programme is good news and offers a great deal to help to improve our country’s health and care system in a gradual and progressive way. Care.data is evolution and not something fundamentally new. We started to collect hospital episode statistics for in-patient data in 1989, for out-patient data in 2003 and for accident and emergency data in 2007-08. The aim is to add primary care data to that list in 2014.

Grahame Morris: Will the Minister give way?

Daniel Poulter: I have not said anything controversial yet, so if the hon. Gentleman will let me make some progress, I will happily give way later.
	To realise the huge potential of health care data, patients and professionals must have absolute trust in the way that the data will be protected and used, together with an understanding of why collecting the data on such a scale is important. I absolutely understand that many people have concerns about how the process might work, but I am confident that the Government amendments will bring further reassurance to the House about the care.data programme.
	The Government fully support NHS England’s decision to delay the start of the care.data programme so that more work can be done to build understanding and confidence. NHS England will be leading that work. In parallel, having listened to key stakeholders and to discussions in this place, the Government have brought forward a package of measures, including amendments to the Bill, to respond to concerns and to give the public greater clarity and reassurance that their data are safe.
	The Health and Social Care Act 2012, which established the Health and Social Care Information Centre, introduced a raft of safeguards to balance the huge benefits that linking health and care data can bring. That offered people greater protection than was previously available. It is worth highlighting some sections of the 2012 Act as examples of that.
	Under section 260, the Health and Social Care Information Centre must not publish the information that it obtains in a form that would enable an individual, other than a provider of care, to be identified. Similarly, under section 261, the HSCIC cannot disseminate share data that could be used to identify an individual, other than a provider of care, except when there is another legal basis for doing so, which could happen in the event of a civil emergency or public health emergency, such as a flu pandemic. Under section 263, the HSCIC must publish a code of practice that makes it clear how it and others should handle confidential data. Under section 264, the HSCIC must be open and transparent about the data it obtains by publishing a register with descriptions of the information. Indeed, the HSCIC is currently working to ensure that it is transparent about all the data it has released to others.
	Moreover, the Government have made the commitment that if someone has concerns about data being used in this way, they can ask their general practice to note their objection and opt out of the system. Following that, no identifiable data about them will flow from their GP record to the HSCIC. Directions to the HSCIC under section 254 of the 2012 Act—separate from the amendments that the House is considering—will ensure that that commitment to patients has legal force.
	We are going further than that. Having listened to key stakeholders and to discussions in Parliament, we have a further package of measures that, in parallel with NHS England’s further engagement activity, will respond to the concerns that we have heard and give the public additional reassurance that their data are safe. Of course, aggregated and anonymised data, which cannot be used to identify any individual person, should and will be made generally available. Indeed, a great deal of research relies on data of this type, where researchers do not need to see any data at the individual person level. Such aggregated and anonymous data are available now, and were available previously through the predecessor body to the HSCIC.
	New clause 34 sets out a number of changes to the 2012 Act which, taken together, clarify when the HSCIC can and cannot release data. The new clause expressly prevents the HSCIC from using its general dissemination power where there is not a clear health care, adult social care or health promotion purpose—for example, for commercial insurance purposes. I am happy to confirm that the new clause enables anonymised information to be disseminated under the HSCIC’s general dissemination power for a wide range of health and care-related purposes, including for commissioning for a wide range of public health purposes and for research relating to health and care services such as the epidemiological research that is needed at the earliest stages of developing new treatments.

Jim Shannon: Can the Minister reassure us that there will be no possibility of private companies obtaining the data and using them for
	their own purposes, instead of their being used for their original purposes in accordance with NHS data protection regulations?

Daniel Poulter: I hope that I have already given the hon. Gentleman some reassurance that the data will have to be used for the benefit of the health and care service, or for the purposes of public health. They are not to be used for insurance purposes, for example. I will go on to outline some of the safeguards involved.

Barbara Keeley: Would the Minister like to comment on an announcement made at the launch of the MedRed BT health cloud—a cloud data system that is using our hospital episode statistics data—in the United States? At the launch, it was stated:
	“People are using foreign data because it’s available. The UK made some gutsy decisions about data liberation. There’s political risk associated and they have a more tolerant climate over there.”
	Will the Minister comment on the fact that we apparently have such a tolerant climate that MedRed and BT are now charging for access to our data on that cloud system in the United States?

Daniel Poulter: I am not going to be drawn into commenting on an American system. The point is that there are strong safeguards under the 2012 Act to ensure that confidential data can be used only for the benefit of the health and care system. Of course, data that do not identify patients need to be used in a transparent way that can help to drive up care and services.

Barbara Keeley: rose—

Daniel Poulter: I have been generous in giving way to the hon. Lady; I hope that she will let me address her point. It is important that we have data that are open and transparent and that are used to expose the quality of care that is available from different health care providers. We are one year on from the Francis inquiry, and we need open and transparent data in order to understand and compare the quality of care services in hospitals and in different NHS health and care providers. This is about helping us to recognise what good care looks like, so that we can extend it throughout the system. It is also about exposing the few examples of bad care in an open and transparent way. If we had—

Barbara Keeley: rose—

Grahame Morris: rose—

Daniel Poulter: I am not going to give way. I am still addressing the hon. Lady’s point, and I am not saying anything controversial. If we had had better, more joined-up data that could have been used in a more transparent way beforehand, we might have been able to head off the events that we saw at Mid Staffs much earlier. This is about protecting patients and the public, and about using population-level data in an open and transparent way. Under the safeguards that we are introducing in the new clause, data will not be used for commercial insurance purposes. Let me give that reassurance.

Andy Burnham: Where in the new clause does it say that? Nowhere does it say that the data cannot be passed to private health insurance companies. Proposed new subsection 1A states that such information could be passed on
	“for the purposes of…the provision of health care or adult social care”.
	This is a very wide provision, and I see no clarity in it that delivers on the commitment that the Minister is giving to the House.

Daniel Poulter: Hopefully, if I am allowed to make some progress and address the points that have been raised, I will give further reassurances a little later. It would be useful—[Interruption.] I will answer the question a little later, so there is no point in heckling or being abusive. If the right hon. Gentleman will wait, I will talk him through the Government’s amendments so that he can gain a better understanding —

Grahame Morris: Will the Minister give way?

Daniel Poulter: No, I will not.

Grahame Morris: Are you afraid?

Daniel Poulter: No, I am not afraid to give way. The hon. Gentleman should sit down, because he often has quite enough to say, and it is not always a very valuable contribution. In this context, he may do well to listen to some of the purposes of the amendments. As I have already outlined, there are strong safeguards set out in the 2012 Act on how data can be used. Data can be used only for the benefit of the health and care system. In order to reassure the public, we have tabled amendments to clarify further how data may be used.
	Speaking to a great many people in recent days, as well as considering amendments tabled by other Members, has prompted the Government to re-table the new clause in order to clarify that these kinds of data may also be disseminated for other wider public health purposes, such as research into environmental factors associated with asthma, or for healthy eating. We have ensured that those other kinds of research can benefit from the data by changing the wording in the new clause to make it clear that information may be disseminated for the purposes of
	“the provision of health care or adult social care”
	or “the promotion of health”. I am sure that the House will agree that it is essential that that valuable data resource is available to support a broad range of health research.
	New clause 34 clarifies that in disseminating information, and indeed in carrying out any of its functions, the Health and Social Care Information Centre must have regard to the need to promote and respect the privacy of those receiving health services and adult social care in England. It also requires the HSCIC to take into account advice from the advisory committee that the Health Research Authority is required to appoint under paragraph 8 of schedule 7 to the Bill. The advice from that committee, known as the confidentiality advisory group, will provide a new level of independent scrutiny of the HSCIC’s decisions to publish or disseminate information.
	Amendment 17 would also enable the confidentiality advisory group to advise the HSCIC on the exercise of functions conferred in regulations under section 251 of the National Health Service Act 2006, or more generally on decisions to disseminate information that could be used to identify individual patients. For example, when new regulations are made under section 251 of the 2006 Act that confer functions on the HSCIC, the confidentiality advisory group could advise the HSCIC on proposals to release data. New clause 34 requires the HSCIC to have regard to that external advice on its exercise of any function under the 2012 Act of publishing or otherwise disseminating information.
	Amendment 18 gives the Secretary of State regulation-making powers to set out the specific criteria that the confidentiality advisory group will be required to take into account in giving advice to the Secretary of State, the Health Research Authority or the HSCIC in carrying out their duties. That provision is intended to enable regulations which would require that the confidentiality advisory group considers: that the purpose for which the data will be used should be in the public interest and for the provision of health and care services; that any approved processing must respect and promote the privacy of patients and care service users; that the purpose cannot be achieved using suitably anonymised data, rather than identifiable data; that it is not reasonably possible to gain explicit patient consent to achieve that purpose; and that the applicant requesting the data has not misused those kinds of data in the past.
	That last criterion would effectively introduce a new “one strike and you’re out” deterrent. Potentially, for some organisations, the risk of no longer being able to access those kinds of data may prove a more effective sanction than the current maximum monetary penalty of £500,000 that can be imposed under the Data Protection Act 1998. Taken together, those measures provide an additional level of scrutiny and assurance to the processes of the HSCIC in publishing or disseminating information. The Government’s amendments—new clause 34 and amendments 17 and 18—provide robust assurance that those kinds of data cannot be disseminated for purposes such as commercial insurance or for assessing an individual’s mortgage application.

Andy Burnham: Before the Minister sits down, I would be very appreciative if he could direct me to the precise part of new clause 34 that prevents a private health insurance company accessing data.

Daniel Poulter: It is clear that the information can be used only for the benefit of the health and care service or for the purposes of promoting health. It is about benefits to the NHS or to the health and care system. That is also what the 2012 Act identifies regarding provision of data. Let us not forget that we had to put safeguards in place because at no point did the previous Government place any restrictions on the use of data. Under the previous Government’s regulations, before this Government came to power, there was greater potential for abuse of the system. Although I am sure the previous Government would not have intended data to be used by private health care companies for insurance purposes or by others, less rigid safeguards were in place to prevent that from happening.
	This Government, both with the amendments and the 2012 Act, have clearly stipulated that the information can be used only for the benefit of the health and care system or the health service. That is very clear and the previous Government never put such a provision in place. This Government have also given patients an opt-out in the use of data—something the previous Government never properly put in place. We have introduced good provisions about protecting confidentiality and using information in the NHS in a responsible manner. If the previous Government had been concerned about the use of data, they should have put in place more robust safeguards when they were in power, but they did not.

Barbara Keeley: Will the Minister give way?

Daniel Poulter: No, the hon. Lady has had many interventions; I have been very generous—[Interruption.] I know she does not like hearing about Labour’s record in government on these issues, but I am afraid she needs to. This Government are putting in place safeguards to protect patient confidentiality. The previous Government failed on that agenda, and I am proud that we are able to table these amendments, which will lead to greater reassurance.
	The amendments also help to clarify how data can be disseminated to support research for health and care commissioning, health and public health purposes, medical purposes, or other purposes relating to the provision of health care, adult social care or the promotion of health.
	Government amendment 8 relates to the remit of the Health Research Authority. It has always been our intention that the HRA’s functions relate to health research and adult social care research, and the amendment clarifies that remit. It makes explicit that the HRA’s functions do not generally extend to research that relates to children’s social care, if that research is solely for the purposes of children’s social care. We must recognise that research may take place across the boundaries between health or adult social care and children’s social care, and the amendment will not inhibit such research. Although the HRA’s functions will not generally extend to children’s social care, the research ethics committees that the HRA establishes or recognises under clauses 113 and 114 will be able to consider children’s social care research in the round when considering a study that also involves health research or adult social care research.
	A lot of research crosses health and social care, and some of it involves children. Where such research includes health elements, it already comes to the HRA special health authority for ethical consideration. Many university ethics committees accept HRA ethics committee approval and do not require separate approval by their own ethics committees. That will continue when the HRA becomes a non-departmental public body.
	Paragraph 12(5) of schedule 7 gives the HRA a general power to do anything that appears to be necessary or desirable for the purposes of, or in connection with, the exercise of its functions. That power means that HRA can, if it feels it necessary or desirable, publish guidance that relates to children’s social care research where there is also an adult social care element or a health element that falls within the HRA’s remit.

Barbara Keeley: On a point of order, Mr Speaker. I understood that this debate was scrutiny of the remaining stages of an important Bill. The Minister seems to be reading his speech into the record, which for me does not stack up as a debate on the remaining stages of a very important Bill, and an aspect of it—care data—that is crucial to every NHS patient in the country.

Mr Speaker: The Minister is certainly in order and there is a continuation of Report stage tomorrow. I am sure he will want to be sensitive to the fact that other Members wish to contribute.

Daniel Poulter: Indeed, Mr Speaker, and I hope that other Members will also be sensitive to that. The more interventions I take, the less opportunities there are for Members to speak. I have been very generous. I have taken interventions on a number of occasions from those on the shadow Front Bench, and from the hon. Member for Worsley and Eccles South (Barbara Keeley) and others. I have been generous with my time, but I want to preserve time for other Members to contribute to the debate, as I see you are keen for me to do, Mr Speaker.
	Although the HRA amendments are important in ensuring that its remit is clearly and accurately defined, it will be able to work with those with an interest in children’s social care research when research crosses boundaries, to seek consistency in standards and to avoid unnecessary duplication.
	Government amendments 15 and 16 are minor and technical. Amendment 15 is consequential to the addition of provisions on the better care fund—part 4—in Committee. It ensures that provisions on commencement cover the better care fund. Amendment 16 removes the privilege amendment inserted in the other place in accordance with the Commons’ sole privilege to deal with monetary matters.
	The Government’s proposals ensure that we correct the difficulties we inherited from the previous Government in preserving confidential patient data. They ensure that we have in place a system in which NHS and care data must be used for the benefit of the health and care system and for public health purposes. They put us in a much better place to ensure that we enhance transparency and better use information to benefit patients. They ensure that we have a better basis on which to understand the basis of disease. If in the first place we had had the Health and Social Care Information Centre and the benefits we know will come from care.data, we would have been able to deal with and better combat many diseases while protecting patient confidentiality. We would have understood much more quickly the dangers of thalidomide and other drugs that were harmful to babies in utero. We would have been in a much better place to expose those examples of poor care, such as Mid Staffs; to develop national frameworks for treating diseases such as chronic obstructive pulmonary disease and heart disease; and to understand what good care looks like in the treatment of those conditions by collecting data in a fundamentally better and joined-up way.
	The Health and Social Care Information Centre will, for the first time, provide us with a repository for joined-up, integrated data across health and care. Hon. Members often rightly talk of integrated care, and of the benefits of joining up health and care. Unless we
	have the data collected to understand what good integrated care looks like, and unless we understand what measures of integration are right, we will not be able properly to inform the debate on delivering integrated care or break down the silos that have sometimes existed to the detriment of patients across the health and care system. I hope hon. Members on both sides of the House can support that. I hope they decently recognise that this Government have put in place not just a patient opt-out if they do not want their data to be shared, but strong safeguards—much stronger safeguards than the previous Government —to protect patient confidentiality.

Grahame Morris: In principle, I support the utilisation of truly anonymised patient data sharing for the purposes of improving public health, but I take issue with a number of the Minister’s points, not least in relation to new clause 25, tabled by my hon. Friend the Member for Copeland (Mr Reed). Accountability is important. If the Minister and the Government are serious about addressing the public’s concern, they would ensure that the Secretary of State and Ministers are responsible rather than an unelected quango. Frankly, the Minister’s assurances at the Dispatch Box this evening, and those given to the Health Committee just a week or two ago, need to be in the Bill, so that there is a level of accountability and some comeback.
	When we debated patient data sharing in Committee and, more recently, in Westminster Hall, my impression was that Ministers have tended to conflate legitimate patient privacy concerns, which are shared by hon. Members and members of the public, with the general lack of support for the utilisation of patient data for further research. They are mistaken, because right hon. and hon. Members are more or less unanimous in supporting any move that can lead to better research, improved care and increased safety.

Barbara Keeley: I am grateful to my hon. Friend for giving way, because the Minister was clearly frightened of answering questions from me and from my right hon. Friend the shadow Health Secretary. The Minister refused even to listen to the question, so I shall ask my hon. Friend: does he think that there is scope for confusion because some companies are in the market of insurance products and health and social care? The Minister would not take the question, so we do not have any answers on how a firm such as BUPA, which is already involved in research and already using the data, could be dealt with.

Grahame Morris: That is a perfect example and an important question that the Minister and the Government should answer. If we are to ensure that we have public trust in the data and who will use them, such questions must be answered and people be given the opportunity to consider what the Government propose.
	It has become clear in recent months that the public lack confidence that the implementation of the care.data scheme as currently proposed would protect the data from inappropriate use, not least because of the point that my hon. Friend has just made. I am sure she would recall that we recently had a Health Committee session on this issue—in fact, the Minister was present—and certain assurances were given, not by the Minister but by one of his officials, that companies outside the
	United Kingdom would not have access to such data. The thought ran through my mind that many private health companies are global in their operations.

Andy Burnham: To add to the theme that my hon. Friend is developing, is not one of the problems with care.data that we have had so many statements from Ministers and officials that have not in the end come to be true? At the last Health questions, the Secretary of State said that a leaflet would be sent to every home in the land to explain what was happening. That also was not true. Does my hon. Friend agree that this is bringing the whole scheme into disrepute?

Grahame Morris: My right hon. Friend has hit the nail on the head, because there has been a catalogue of mismanagement. What we need to do if we believe in the importance of such a database is to ensure that we rebuild public trust. The Government have an opportunity to do that, but it will not be a simple matter. We have to look carefully at the implications of what the Government propose and give the necessary assurances.
	The assurance that the official gave to the Health Committee had a gap that a coach and horses could be driven through. Several multinational companies could get round it by establishing a subsidiary based in the UK that would have access to the data, if that were the only safeguard.

Stephen Dorrell: I want to return to a theme that we were discussing in an earlier debate this evening. The true nature of the hon. Gentleman’s concern is unclear. If his concern is that sensitive patient information should be made available only on the basis that the identity of the individual can never be traced and the data remain properly anonymised and confidential, I think that concern would be shared on both sides of the House. But is that his real concern, or is it that the information might be used by a private sector body for the purpose of improving the delivery of health care? I am not clear, provided that the information is anonymised and patient identity is properly secured, what his objection could be.

Grahame Morris: I thought I was being fairly clear. In the debate on the earlier group of amendments, we discussed the privatisation of the clinical commissioning function. My concern is that that would lead to greater fragmentation, not greater co-operation. On data sharing, I think it was my hon. Friend the Member for Leicester West (Liz Kendall) who gave the example of a questionnaire she was asked to fill in by her GP, which contained questions relating to alcohol consumption, smoking and so on. If that information was made available to a private health care company and, as a consequence, premiums were increased, people would have concerns. The Minister said that that has been ruled out and that it would not happen, but it is an example of why such concerns have been raised.

Oliver Colvile: It is very important for there to be as much protection for the individual and the patient as possible. I assure the hon. Gentleman that my medical records are particularly uninteresting, but I would not want them to be leaked to an insurance company seeking
	to make money out of them or trying to change my premium. I am sure that that is very important in people’s minds.

Grahame Morris: The hon. Gentleman makes an interesting point which echoes a point made on the Labour Benches a few moments ago. The problem is that a number of private health care companies are also insurance companies, so it would be quite a task to ensure that data are not shared with companies that might have a commercial interest in them. To restrict access in the way we would all want is not as simple as the Government would have us believe.

Andrew George: The hon. Gentleman and I often agree on these issues, but I am slightly concerned. Of course we want reassurances, and while we have the pause we should seek further reassurances on the anonymisation of data and that they will not be misused. How far is he prepared to push this point? Is he prepared to push it to the extent that the initiative falls, with all the consequences for the lack of progress in advances in medical care? In 10 years’ time we could be talking about hundreds of thousands of lives that could have been saved as a result of pressing on with this very important development.

Grahame Morris: The hon. Gentleman makes an excellent point. It is not my intention to do that, but we have to recognise that the public awareness campaign—the Government’s early assurances about leaflets and letters—has been wholly inadequate. At a time when it is important for the Government to instil public confidence in the scheme, they keep doing things that undermine public confidence, for example by giving the hated company Atos—if you do not mind me using the term, Mr Speaker, because of the debacle in the Department for Work and Pensions—the contract to extract the data. There seems to have been a catalogue of errors.
	I accept that this proposal has the potential to be a huge step forward. The Minister said it was not revolutionary, but I am quite often in favour of things that are revolutionary. It is revolutionary, because previous data collections from a hospital-based setting, from secondary care, have been largely episodic. This scheme will harvest data from GPs and primary care to follow the whole of the patient journey, and to identify trends and follow-ups. That is a revolutionary step forward, provided we have the necessary safeguards and assurances, and that we rebuild public trust. I am not suggesting that the scheme is unworkable and cannot be reformed, but there is a huge job to do to ensure that we restore public confidence.

Barbara Keeley: Will my hon. Friend give way?

Grahame Morris: I wanted to mention an example that has been presented to me in relation to rare illnesses. It is suggested that a patient could never be identified from the data, but identification might be possible in the case of very rare conditions, particularly if pharmaceutical companies had their own databases. We need some form of protection to cover those circumstances as well.

Barbara Keeley: I thank my hon. Friend: he is being very generous in giving way. Does he agree that scope is an issue? The Hospital Episode Statistics database was
	an administrative database, and that is what our data were being used for. My hon. Friend has made an important point about the loss of trust. When did any of us sign up to having our data used to recalculate the cost of insurance cover for long-term illness? When did we sign up to have it sold on a chargeable basis by BT and by MedRed, on its cloud system in the United States? Once control has gone, it is possible for the scope to vary all over the place.

Grahame Morris: That is a good point. It is very important for the Government to lay down parameters for the scope.
	The sharing of medical data has a fantastic potential to do good, as long as the necessary safeguards are there, but if it is mishandled, it also has the potential to do great harm. Patient data consist of very confidential information, which could prove damaging to the public if it were to end up in the wrong hands. We have already seen examples of that. I share the public’s fear that the Government are not seeking appropriate safeguards in respect of highly personal and sensitive information. Despite the Minister’s assurances about new clause 34, I do not think that it goes far enough.
	Let me return to the issue of accountability. The benefits for companies that seek to misuse or leak patient data, for example, are considerable. The Minister has ruled out insurance companies, but I am worried about private health care firms. The pharmaceutical industry could profit from the re-identification of patient records, and I believe that the absence of parliamentary accountability to which I referred earlier, and a lack of clear and harsh penalties for those who misuse data, are undermining trust in what could be a highly beneficial scheme. Subsection (2) of new clause 25 defines misuse, and subsection (3) gives an indication of the penalties that would be applied. I think that they might act as a deterrent.

Jamie Reed: My hon. Friend is making an excellent, intelligent and informed speech. The charge has been made that pushing our proposals too far risks scuppering the project, but is it not the case that the more safeguards we can introduce to reassure the public, the better the prospects of its success will be—and, moreover, the greater the data sample will be, and the better the system will be as a result?

Grahame Morris: I entirely agree. I think that that is vital, because, as we have seen in the case of politicians following the expenses scandal, once public trust has been lost, it is a huge task to win that trust back. There is a mountain to be climbed. I therefore think it important that we get this right.
	The Government have an opportunity to pause the implementation of the Bill in order to consult properly, and, in the Bill itself, to address issues that have been raised by Members in all parts of the House and by other interested parties. I believe that if there is to be public confidence in the scheme, the Government should make a gesture by supporting Labour’s new clauses, particularly new clause 25. Given that the misuse and identification of data are the prime concerns of the public, I think that it would be eminently sensible to
	make them an offence. That is not rocket science, is it? If that is the problem, why do we not address it directly by creating an offence? Similarly, if an organisation makes applications for data from the Health and Social Care Information Centre, it should have to disclose any previous convictions under that offence. I am a big supporter of transparency and the extension of freedom of information. Private health care companies should disclose information that is relevant in those circumstances.
	It seems bizarre to insist that the public should allow their private information to be shared with organisations that are allowed to hide their chequered pasts in some cases behind the cloak of commercial confidentiality. Parliamentary accountability, too, should be introduced to the decision-making process. The Secretary of State should retain the duty to approve any applications. The buck should stop with the Secretary of State. If there is a serious commitment to win back the public’s trust on care.data, the buck should stop with the Secretary of State, rather than with a big and unaccountable quango.
	It would be of great benefit to the public if data sharing were exercised in an accountable and secure manner. I have always been an advocate of investment in public health. For that to be effective, we need an evidence base on which to plan interventions. The scheme is set to be disrupted unless the Government can demonstrate that they are serious about protecting patients’ privacy.

Oliver Colvile: Does the hon. Gentleman think that there will be a problem with patients sharing that information with their pharmacists if that meant that they were going to get better more quickly?

Grahame Morris: On an individual basis, I do not see a problem with that. The problem arises when dealing with large volumes of harvested data that include not just primary care records of patients in the community but hospital records, where pharmaceutical companies are perhaps able to benefit. Whether that is in patients’ best interests needs further consideration. I do not think that there is any such concern about individual conversations with GPs or pharmacists, but there are still major holes in the Government’s proposals. They need to be tightened further. A good starting point would be Labour’s new clause 25.

Paul Burstow: The hon. Gentleman has been incredibly gracious in giving way on several occasions. He has said that new clause 25 should be commended. I wonder whether he has considered amendment (b), which suggests that one of the other issues about safeguarding data is people being satisfied of the competence of the organisations that will receive that data and that they comply fully with the data protection obligations.

Grahame Morris: I have considered that, and that is an important point. Compliance is important. Those issues should be addressed in the Bill. If we are to ensure that there is public trust, those points must be addressed.

Jamie Reed: Does my hon. Friend share my concern and that of many GPs that the lack of necessary safeguards in the Bill may have an unintended consequence, particularly among the hardest to reach groups in society?
	Fear about the lack of safeguards in the Bill may stop them from accessing GPs and sharing their details and problems with them.

Grahame Morris: That is a huge danger. We have an opportunity to address that in this House this evening and when we consider the Bill further tomorrow. I personally am not advocating that people sign up to the opt-out clauses. That is important, but we need assurances to be able with confidence to support the Bill and the data collection proposals.

Several hon. Members: rose—

Mr Speaker: Order. One might have thought the intervention of the hon. Member for Copeland (Mr Reed) was exquisitely timed.
	Bill to be further considered tomorrow.

Business without Debate

DELEGATED LEGISLATION

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Pensions

That the draft Automatic Enrolment (Earnings Trigger and Qualifying Earnings Band) Order 2014, which was laid before this House on 15 January, be approved.—(John Penrose.)
	Question agreed to.
	Motion made, and Question put forthwith (Standing Order No. 118(6)),

Electricity

That the draft Warm Home Discount (Amendment) Regulations 2014, which were laid before this House on 20 January, be approved. —(John Penrose.)
	Question agreed to.

Mr Speaker: With the leave of the House, we shall take motions 5 and 6 on family proceedings together.
	Motion made, and Question put forthwith (Standing Order No. 118(6)),

Family Proceedings

That the draft Access to Justice Act 1999 (Destination of Appeals) (Family Proceedings) Order 2014, which was laid before this House on 27 January, be approved.

Family Proceedings

That the draft Crime and Courts Act 2013 (Family Court: Consequential Provision) Order 2014, which was laid before this House on 27 January, be approved. —(John Penrose.)
	Question agreed to.
	Motion made, and Question put forthwith (Standing Order No. 118(6)),

Family Court

That the draft Justices’ Clerks and Assistants Rules 2014, which were laid before this House on 27 January, be approved. —(John Penrose.)
	Question agreed to.

EUROPEAN UNION DOCUMENTS

Motion made, and Question put forthwith (Standing Order No. 119(11)),

Gender Equality and Women’s Empowerment in Development

That this House takes note of European Union Document No. 17432/13, a Commission Staff Working Paper: 2013 Report on the Implementation of the EU Plan of Action on Gender Equality and Women’s Empowerment in Development 2010–2015; welcomes the document as a frank assessment of the EU’s implementation of its Action Plan; and supports the Government’s efforts in encouraging the European Commission to address the weaknesses identified in the Report in order to ensure further integration of gender equality in EU development assistance.—(John Penrose.)
	Question agreed to.

ADMINISTRATION

Ordered,
	That Karen Bradley, David Morris and Nicholas Soames be discharged from the Administration Committee and Harriett Baldwin, Conor Burns and Mr Mark Harper be added.—(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)

STATUTORY INSTRUMENTS (JOINT COMMITTEE)

Ordered,
	That Mr Robert Buckland be discharged from the Joint Committee on Statutory Instruments. —(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)

WELSH AFFAIRS

Ordered,
	That Hywel Williams be discharged from the Welsh Affairs Committee and Jonathan Edwards be added.—(Geoffrey Clifton-Brown, on behalf of the Committee of Selection.)

PETITIONS

North Corner Quay and Landing Stage, Devonport

Oliver Colvile: It is with great delight that I take this opportunity of presenting Parliament with a petition by about 1,000 of my constituents within the Plymouth travel-to-work area who are concerned about the north corner quay and landing stage in Devonport.
	The petition states:
	The Petition of residents of Devonport and Plymouth, and others,
	Declares that the Petitioners are concerned about the condition of the North Corner Quay and Landing Stage, Devonport.
	The Petitioners therefore request that the House of Commons urges the Secretary of State for Communities and Local Government under his powers contained in Part IV, Clause 48 of the Plymouth City Council Act (1987) to encourage Plymouth City Council to restore and repair North Corner Quay and Landing Stage as contained in Part IV, Clause 26 of the said Act.
	And the Petitioners remain, etc.
	[P001324]

South Stoke Plateau (Bath and North East Somerset)

Jacob Rees-Mogg: Her Majesty’s Government have been fantastic in saving my constituency from development in the green belt, and the Communities and Local Government Minister, my hon. Friend the Member for Grantham and Stamford (Nick Boles), has been particularly good in recently stopping these incursions, but my constituents in South Stoke are especially concerned about development that may take place there and I have 1,386 signatures to this petition. That number is easy to remember because, 1386 was the year of the treaty of Windsor.
	The petition states:
	The Humble Petition of the residents of the parish of South Stoke and its neighbouring parishes and wards of Bath and North East Somerset, here represented by South Stoke Parish Council and The South of Bath Alliance,
	Sheweth that it is the intention of Bath and North East Somerset District Council's Amended Core Strategy to develop the land known as the Odd Down/ South Stoke Plateau with the building of 300 new homes.
	Wherefore your Petitioners pray that your honourable House ask Her Majesty’s Government to recognise the importance of the openness of this land, which forms part of the Setting of the Bath World Heritage Site and of the Wansdyke Scheduled Ancient Monument, and to maintain the current Statutory protections of the Green Belt and Area of Outstanding Natural Beauty designations for all of the South Stoke Plateau and so maintain the site free of development in perpetuity.
	And your Petitioners, as in duty bound, will ever pray, &c
	[P001330]

ST HELIER HOSPITAL

Motion made, and Question proposed, That this House do now adjourn.—(John Penrose.)

Siobhain McDonagh: At the beginning of this month, on a crisp, cold Saturday morning, I joined a group of residents outside our local St Helier hospital to mark a sad moment in its history. For the past four years, St Helier has been adorned by a 1,000-square-feet banner, proudly saying, “Coming soon—We’re spending £219m on a major development of St Helier hospital”. The residents and I were there to see that banner taken down, and to mark the promise of a better hospital finally being taken away. The story of St Helier is a long one. I have raised it in this House on several occasions. This was a low point, but I fear that it may get lower, and the result of today’s debate does not exactly inspire confidence.
	St Helier was built in the 1930s, at the same time as the St Helier housing estate that encompasses it. At that time, it was the biggest housing estate in Europe. The hospital was built there for a reason: it was where the health needs of the surrounding community were. St Helier hospital has had an interesting history. In the second world war, its bold white exterior was painted green owing to concerns that German bombers would use it for target practice or to line up their bombing missions on London. Although neighbouring buildings were destroyed by bombers, St Helier thankfully survived and has continued to serve the community ever since.
	St Helier has had its troubles. In the mid-1990s, there was outrage when it was discovered that people were left to die on trolleys abandoned in the corridor. Back then, under-investment in the NHS of the John Major Government was not unusual. If it was bad on the wards, however, what was happening behind the scenes was almost as disturbing.
	Even though Mitcham and Morden has always been the most deprived part of the old health area of Sutton, Merton and Surrey, it has always been the poor relation. In my almost 17 years as an MP, and for many before that, I have never known of anyone living in Mitcham and Morden to sit on the board of any NHS body. As a result, we have always had a Cinderella service. No one speaks up for our patients, and we are always first to lose out and last to gain. It was no surprise, therefore, when I discovered recently that health bosses had held secret meetings in the mid-1990s to discuss plans to close St Helier and move services to Croydon. Thankfully, once Labour came to power in 1997, this went no further, but the tone was set.
	Not long afterwards, it was suggested that St Helier should merge with the hospital in Epsom. Such a merger was a little unusual, but Epsom was struggling financially, and we were persuaded that a merger would make both hospitals more resilient. The two hospitals were not a great match. People living in Epsom are relatively wealthy, and a little older. The area around St Helier is more urban, ethnically mixed, younger and has more health problems associated with poverty. Nevertheless, we accepted the advice, but it soon became clear that we had been sold a pup.
	A new review, “Better Healthcare Closer to Home” was launched. This was in a time of plenty, the early 2000s, when health spending was on the rise, so a grand
	scheme was drawn up, in which St Helier and Epsom would both close, replaced by a new state-of-the-art hospital in Belmont, a very leafy, very wealthy community two miles south of Sutton. Aside from the terrible impact of closing St Helier, I never thought that the scheme was workable; it was too big, too unrealistic and lacked one key ingredient—any public demand for it.
	Various bureaucrats argued that the site of a hospital is not important, because new community primary care services, such as GPs and local care centres, would see the patients that normally go to hospitals instead. The public never agreed, and in fact the reverse has happened: the number of people who would rather go to hospitals is rising. The public consultation at the time clearly showed that the most popular site for a hospital with an A and E was St Helier. The public knew that the people who need hospital the most are the most disadvantaged, with the worst health. They are the most likely to need A and E and the most likely to need acute maternity services.
	Everyone could see that St Helier was the best location for a hospital if we wanted to reduce health inequalities, and it was backed by all the MPs in Sutton, Merton and Wandsworth. Local managers overruled us and, even though their initial assessments showed that St Helier was a 7% better option than Belmont, they voted for Belmont instead. Thankfully, in those days we had a Secretary of State for Health who was prepared to step in and stand up for the NHS. The health managers’ decision was finally called in by Labour councillors in the London borough of Merton, and the then Secretary of State decided to save St Helier, recognising that the area around St Helier had the greatest health needs in the whole catchment area and people there had up to 10 years’ less life expectancy. In contrast, Belmont is one of the wealthiest areas in the country. Indeed, people living there also made it clear they did not want a major new hospital built in their backyard. So we were all delighted when the then Government came down firmly on the side of reducing health inequalities and chose St Helier.
	In early 2010, that decision was further boosted when a subsequent Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), announced the £219 million renovation. At the time, we were all very aware that the economy could no longer afford the same generous public sector funding we had in the mid-2000s. Decisions had to make financial sense and, in the case of the £219 million, the numbers stacked up. As well as improving people’s health, the scheme was shown to offer value for money. It would mean new wards, with single rooms to cut down on infections and improve patient privacy, along with various other improvements. The scheme was so well thought out that just months later it also gained the support of the new coalition Government—the Chancellor still includes the funding in the Treasury’s books—but it was not long before St Helier’s future was again at risk.
	In 2011, the local NHS admitted that it had received Government instructions
	“to deliver £370 million savings each year...a reduction of around 24% in their costs.”
	A new body was soon set up, this time called Better Services Better Value, or BSBV— it might properly be abbreviated to just BS for all the good it has done. Its task soon became clear: to close services such as accident
	and emergency, and maternity units, in one or more hospital. At the same time, finally recognising that they served different demographic groups, the St Helier and Epsom hospitals started to de-merge from the trust. Both had found new trusts willing to merge with them, St Helier with St George’s Healthcare NHS Trust and Epsom with Ashford and St Peter’s Hospitals NHS Trust, but, thanks to BSBV, those new mergers soon broke down. Nobody wanted to merge with a hospital that was under threat, particularly when it was revealed that Epsom’s debts were far worse than originally thought.
	Originally, BSBV would look only at south-west London, covering St Helier, Kingston, Croydon and St George’s in Tooting; one of the four would lose its accident and emergency unit. But after the de-merger fell apart, the review was extended into Surrey, and two out of five hospitals were to be downgraded—inevitably, BSBV recommended that St Helier should be one. Not only would its A and E and maternity units go, but so, too, would its intensive care unit, paediatric centre, renal unit and 390 in-patient beds.
	I have always said that the sums do not add up. Some 82,000 patients go to St Helier’s A and E each year, with the NHS saying that figure will rise by 20%—100 emergency patients are admitted every day. Neighbouring hospitals are already overcrowded, and are more expensive per patient, so it was never clear how the other hospitals could meet clinical targets, let alone cut costs, if they had to treat St Helier’s patients as well as their own. Figures quoted by BSBV—that an astonishing 60% of patients would use primary care instead of A and E departments—were ridiculed by the National Clinical Advisory Team, who said:
	“Elsewhere in the UK a consistent finding is...far lower, usually...15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”
	In fact, NCAT went a lot further than that, saying:
	“Successful implementation...depends on a multitude of supporting improvements...that are not well defined in the proposals.”
	Given the growing birth rate and the higher cost of giving birth in all other hospitals, closing St Helier’s maternity unit was also never going to deliver clinical targets or cut costs. Experts say that maternity units should not deliver more than 6,000 babies per year. However, if St Helier closed, the remaining hospitals would have to deliver 6,500 babies each per year, plus 2,500 in midwife units and nearly 1,000 home births. It was no surprise, therefore, that NCAT said the plans were
	“based on an optimistic view of capacity.”
	Everyone in my local community knew the plans were bonkers. Local campaigners such as Sally Kenny, a former deputy head and Lower Morden resident, set up local groups to fight the plans. Sally has printed thousands of “Save St Helier” posters that are currently in windows across Morden and St Helier. People cannot drive through the area without seeing the words “We Love St Helier” displayed on garden stakes.
	As well as a petition signed by more than 30,000 people, thousands of local residents attended a protest picnic organised by local mums, where the leader of Merton council, Stephen Alambritis, a former football referee, waved a red card at the plans. Merton council has always shown its support. Last year, it passed a strongly worded motion backed by Labour, Liberal Democrat, Conservative and Independent councillors, saying any
	decision on St Helier must go to the Secretary of State. Thankfully, salvation came from an unlikely source—a clinical commissioning group in Surrey.
	In Merton, the new system of CCGs has not been a great advert for the Government’s reforms. Last May, I attended one of the worst public meetings I have ever been to—and that is really saying something. Merton’s CCG was due to decide St Helier’s future, but it would allow only a handful of the hundreds of people who came to the meeting into the public gallery. The chair would not allow cameras or recordings, and the microphones did not work. Members of the CCG refused to register their personal interests, even though it was alleged that some would gain personally if St Helier were shut and services were moved to other providers such as private companies or GP surgeries. Then, just as they were due to make a decision, they suddenly walked out of the room to boos and shouts of “cowards”. Some said that they had adjourned the meeting to a quiet staircase, others that they went to the kitchen. Wherever they went, they made the decision there, in secret, without any public witnesses, to accept plans to close services at St Helier and to go to public consultation.
	If Merton’s CCG was not exactly the blueprint of an open, transparent community service, thankfully others did not follow suit. Having seen the power of GPs in Lewisham, the CCG in Surrey Downs, recognised that BSBV was barking up the wrong tree and voted no. As a result, earlier this year, BSBV was wound up; it will not be mourned. However, the threat still hangs over us.
	I have been shown a letter from NHS England to the CCGs complaining about their decision not to approve closures at St Helier. The letter says:
	“Your approach carries significant and unacceptable risk, both financially and clinically.”
	Castigating the CCGs for their decision, it goes on:
	“We consider your proposed approach would make it difficult for South West London CCGs to formulate a coherent strategic plan.”
	According to NHS England, the decision
	“carries unacceptable risks to your ability to develop and deliver a strategic plan. We also believe the approach carries significant operational risks. Firstly that your providers will not be able to meet the London Quality Standards...Secondly, that providers will not be able to recover their costs against income and therefore...will be unable to become Foundation Trusts.”
	Most damning of all, it says:
	“This could be interpreted as commissioners planning for clinical and financial failure in some of its providers.”
	That letter is very revealing. It proves that those in charge still cannot bring themselves to rule out the possibility of St Helier closing. They are planning to fail, and if they do not fail, they will not allow St Helier to become a foundation trust anyway. Either way, the hospital will fail. That indicates that the announcement not to close St Helier is not real. As if we needed more evidence that the Government are not committed to St Helier, we heard, just a few weeks later, that the £219 million had been withdrawn. After I had repeatedly asked about the lack of progress, the head of Merton’s CCG finally conceded the truth. Ruefully, she admitted that the work was now “probably unaffordable” and no longer featured as
	“one of the...scenarios being worked up by the Trust at this stage.”
	The whole community knows what is going on. St Helier is not “safe”. It does not have the Government’s backing. If the Government truly still supported St Helier, why is it not full steam ahead with a scheme that has funding from the Treasury and that has proven its clinical value? They are failing to plan, and planning to fail. All this ends in one place: the demise of St Helier. If St Helier loses emergency services, 200,000 people will face longer journeys in an emergency. A and Es across south London will struggle to cope with the extra workload, and that will affect millions of patients, including the Minister’s constituents.
	The Minister has a chance today to offer some hope. She is a significant person. A word from her could make all the difference. All she has to say is that St Helier will stay open and that she will not allow it to lose its A and E, its maternity unit or any of its other services. She can say today that the £219 million must be spent. When that money was announced four years ago, construction was due to begin in 2012. Nothing has happened, but this evening she can turn nothing into something with just a word. She will probably say it is for others to decide, but that is her decision. A decision not to act is just as much a decision as any other. What she should do is show leadership, because leaders decide. Without ministerial commitment to St Helier, it is clear where this will end. They are planning to fail, and that is why the fight goes on.
	All the while, the population in south London is rising, demand for hospital services is increasing, demand for A and E is going up by 20%, and the birth rate is rocketing. Doctors oppose the closure of services, Merton council unambiguously opposes any closure, and all parties want to save St Helier. We thought things were bleak before; they are just as bleak now.
	All the while, instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. The UK Statistics Authority has made it clear that the Prime Minister has broken his election pledge to increase health spending. If St Helier loses its A and E or countless other services, my constituents will know why. They are angry. In Mitcham and Morden we demand nothing less than a moratorium on A and E closures. We want our hospital, St Helier, to continue. The German bombers never destroyed it, nor should this Government. The Minister needs to say, “Yes, the £219 million is still there, and yes, the building work will start now.”

Jane Ellison: I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing one of a number of debates that she has led in the House on this issue. I know that it is important to her—we have had many private conversations about it over the past few years—and to her constituents. She has great faith in my powers, but I fear that so soon after the collapse of Better Services Better Value, I am inevitably not in a position to say anything particularly definite to her tonight. However, I will try to respond to some of the points she makes and explain to the House what the road map ahead now looks like. Overall, although I understand her frustration, which is felt by many of us who represent south-west London, I think her analysis is a little bleak, but I will try to give her
	some assurance about the potential for the future, if not about some of the specific points that she asked me to address.
	Before I comment on the issues that the hon. Lady has raised, I want to pay tribute to all those who work in the NHS in her constituency and in all our constituencies in south-west London. Throughout all the uncertainties of the past few years, they have continued to show their commitment to providing first-class services to all those in their care. For that, we thank them.
	As I said, I share the hon. Lady’s frustration about this programme—I say that straight away on the record—as, I am sure, do all those of us affected in the area covered by the six clinical commissioning groups. For many of us, having spent so much time in consultations, meetings and discussions, it is, to say the least, very frustrating to find ourselves in this position on BSBV.
	I give the hon. Lady the assurance that the Department of Health remains committed to investing in NHS infrastructure. The most recent Government spending review has ensured that capital spending in the NHS is protected in real terms. That means that the NHS will be getting a real-terms increase in spending in 2015-16 compared with 2014-15. There is, therefore, money available for capital infrastructure, but I realise that the hon. Lady’s interest is in her own local capital investment.
	At the same time, I fully understand the hon. Lady’s disappointment that Epsom and St Helier University Hospitals NHS Trust has been unable to progress its plans for developing St Helier. However, as the hon. Lady knows, the problem is that in the absence of a local agreed strategy for south-west London and a decision on which services will be located at the redeveloped site, the trust has recently decided to reconsider the scheme.
	As the hon. Lady is also aware, the proposed redevelopment has been closely linked to Better Services Better Value and the review of clinical services right across south-west London. That has gone on for so long that, in many ways, events have overtaken it and there is now a need to look at it afresh.
	The six clinical commissioning groups in south-west London announced on 18 February that they did not propose to continue with the BSBV programme or to consult on the options that emerged from it, so they have now been withdrawn. As a result of that decision by the CCGs, the trust now needs to reconsider the business case for the hospital redevelopment and it plans to work with the local CCGs to see whether they can agree a level of investment in the hospital that is affordable and that ensures that the services provided are sustainable.
	The trust has confirmed that over the next five years it plans to invest up to £78 million in modernising its estate, improving facilities for patients and updating IT systems and equipment. I think, therefore, that the picture the hon. Lady painted was a little bleak, because it suggested that there was to be no investment at all, when in fact the trust has announced that it intends to go ahead with plans that will enhance some of the services for her constituents.

Siobhain McDonagh: It is my understanding that any capital works of that size would have to be approved by the Department of Health and the Treasury, and as yet
	I do not believe they have been drawn up to the extent that they have any such permission, so at the moment this is wishful thinking on the part of the trust.

Jane Ellison: The trust has announced its intentions, and a proper process will be followed. I am trying to make the point that it is wrong to suggest that there are no plans to invest in and enhance services at St Helier. That process will be followed and we will respond in due course. That is my understanding of the trust’s plans and it wants to progress with them.

Paul Burstow: I am grateful to the hon. Member for Mitcham and Morden (Siobhain McDonagh) for calling for this debate. Will the Minister use her good offices to ask the trust to set out very clearly to all hon. Members representing constituencies with an interest in St Helier its plans and the timeline for this capital investment?

Jane Ellison: That is an entirely reasonable request and I will, of course, convey it to the trust following this debate.
	The local CCGs have listened to feedback from local people and they have now told us that they want to look at local health services in a more holistic way. Although they have decided against proceeding with BSBV, the local CCGs have unanimously supported the clinical case for change in south-west London and propose to use the detailed analysis provided by that exercise to plan their future strategy. I accept that that is a broad-brush explanation and that we have yet to see the detail, but that is essentially the direction of travel. Obviously we are not as far forward as we would have wanted to be after all the consideration given to the issue over the past few years.
	The CCGs have also made it clear that if they do not address the challenges identified under BSBV or, at a national level, those in NHS England’s “Call to Action”, local services might decline in quality and not be able to meet the required safety standards. The CCGs have agreed that all future hospital services should be commissioned against the London quality standards and that all hospitals must provide seven-day-a-week, consultant-led services.
	I referred earlier to events overtaking the BSBV programme, and the CCGs need to take into consideration some of the more recent developments, not least Sir Bruce Keogh’s review of urgent and emergency care. We need to look at the whole of the south-west London health economy in the light of those new expectations, particularly that for seven-day-a-week, consultant-led services. That is a challenge right across the NHS, not least for those of us in south-west London. Hospitals are expected to comply fully with the recommendations set out in the Keogh review and, of course, to be financially sustainable.
	Should the outcome of discussions mean major changes at any trust in south-west London, proposals will, of course, be subject to public consultation. Most importantly, the local NHS has stated that it will involve local people in the work to develop these new solutions to the longer-term challenges faced by the NHS in the area.
	As well as involving local people, it is absolutely essential to involve local Members of Parliament. I take the point made by the right hon. Gentleman in his intervention. Whenever I meet representatives of NHS London, as I do from time to time—another meeting is
	in the diary—I always stress the importance of liaising very closely with Members of Parliament so that they can best represent their constituents and make sure that they are fully in the picture about developments. For the record, I was not particularly impressed by the notice I got of BSBV not going forward, given that I have to respond in this House about it, and I have made that view clear to some of the people in my local area.
	Epsom and St Helier trust has made it clear that the broad range of in-patient, out-patient and day services remains available at its two hospital sites. Local CCGs will work together—the new umbrella name is South West London Collaborative Commissioning—to develop a five-year commissioning strategy. The trust will work with its commissioners in the coming months to contribute to those plans. I understand that the trust expects to see the strategy in June, which will give it a clear idea of the future direction of local health services and its role in delivering them. As local Members of Parliament, we all expect to see the strategy at the same time.
	Once a decision has been made on which services will be located at St Helier, the trust will need to revisit its original business case for the redevelopment of the site. I realise that that is frustrating, after everything that local people have campaigned on, but that is in its nature: it was only ever an outline business case. Any
	new or updated business case for redeveloping St Helier would initially need to be considered by the NHS Trust Development Authority, which is responsible for approving capital funding and ensuring that the repayments are affordable for the trust. As much is likely to have changed in the four years since the business case was last considered, it will probably be reviewed again by the Department of Health and the Treasury.
	It is obviously essential that any options must be sustainable in the long term, both financially and, as I mentioned in relation to the Keogh review, clinically. When local consultations have taken place and have determined a sustainable service configuration for the locality and the hospital, we anticipate that requests for capital funding will be submitted to the Department of Health for consideration.
	In conclusion, I urge the hon. Lady and other Members of the House to continue to represent their constituents, engage with the process and participate in future consultations. What we all want to emerge from the process is a sustainable, safe and excellent local health economy for south-west London that works to the most modern standards of care and is sustainable for the long term.
	Question put and agreed to.
	House adjourned.